TFPI inhibitors and methods of use

ABSTRACT

The invention provides peptides that bind Tissue Factor Pathway Inhibitor (TFPI), including TFPI-inhibitory peptides, and compositions thereof. The peptides may be used to inhibit a TFPI, enhance thrombin formation in a clotting factor-deficient subject, increase blood clot formation in a subject, and/or treat a blood coagulation disorder in a subject.

CROSS REFERENCE TO RELATED APPLICATIONS AND INCORPORATION BY REFERENCE

This application is a divisional of U.S. patent application Ser. No.12/643,818, now U.S. Pat. No. 8,466,108, filed Dec. 21, 2009, whichclaims priority to U.S. Provisional Patent Application No. 61/139,272,filed Dec. 19, 2008, the disclosure of which is incorporated byreference in its entirety.

TECHNICAL FIELD OF THE INVENTION

The invention generally relates to peptides that bind Tissue FactorPathway Inhibitor (TFPI) and uses thereof.

Incorporated by reference in its entirety is a computer-readablenucleotide/amino acid sequence listing submitted concurrently herewithand identified as follows: ASCII (text) file named“44241ADIV_SubSeqListing.txt,” 975,174 bytes, created on May 7, 2013.

BACKGROUND OF THE INVENTION

Hemostasis relies on the complex coagulation cascade, wherein a seriesof events mediated by blood clotting factors lead to conversion ofprothrombin to thrombin. Factor X (FX) activation is the central eventof both the intrinsic and extrinsic pathways of the coagulation cascade.The extrinsic pathway has been proposed as the primary activator of thecoagulation cascade (Mackman et al., Arterioscler. Thromb. Casc. Biol.,27, 1687-1693 (2007)). Circulating Tissue Factor (TF) and activatedFactor VII (FVIIa) interact to form the “extrinsic complex,” whichmediates activation of FX. The coagulation cascade is amplified by theintrinsic pathway, during which successive activation of factors XII,XI, IX, and VIII results in formation of the “intrinsic” FIXa-FVIIIacomplex that also mediates FX activation. Activated FX promotes thrombinformation, which is required for the body to create fibrin andeffectively curb bleeding.

Severe bleeding disorders, such as hemophilia, result from disruption ofthe blood coagulation cascade. Hemophilia A, the most common type ofhemophilia, stems from a deficiency in factor VIII, while hemophilia Bis associated with deficiencies in Factor IX (FIX). Hemophilia C iscaused by a deficiency in Factor XI (FXI) (Cawthern et al., Blood,91(12), 4581-4592 (1998)). There is currently no cure for hemophilia andother clotting diseases. Factor replacement therapy is the most commontreatment for blood coagulation disorders. However, blood clottingfactors typically are cleared from the bloodstream shortly afteradministration. To be effective, a patient must receive frequentintravenous infusions of plasma-derived or recombinant factorconcentrates, which is uncomfortable, requires clinical settings, isexpensive, and is time consuming. In addition, therapeutic efficacy offactor replacement therapy can diminish drastically upon formation ofinhibitory antibodies. Approximately 30% of patients with severehemophilia A develop inhibitory antibodies that neutralize Factor VIII(FVIII) (Peerlinck and Hermans, Haemophilia, 12, 579-590 (2006)). Fewtherapeutic options exist for patients with anti-Factor antibodies.

Thus, there exists a need in the art for compositions and methods fortreating blood coagulation disorders. The invention provides suchcompositions and methods.

SUMMARY OF THE INVENTION

The invention provides peptides that bind to Tissue Factor PathwayInhibitor (TFPI), including TFPI antagonistic peptides having theability to modulate the blood coagulation cascade. For example, theinvention provides a peptide comprising the amino acid sequenceX₇X₈X₉X₁₀X₁₁X₁₂X₁₃X₁₄X₁₅X₁₆X₁₇X₁₈X₁₉X₂₀X₂₁(SEQ ID NO: 3109), wherein

X₇ is selected from the group consisting of L, P, K, S, W, V, N, and Q;

X₈ is selected from the group consisting of L, R, N, F, and I;

X₉ is selected from the group consisting of Y, V, P, and C;

X₁₀ is selected from the group consisting of F, L, and G;

X₁₁ is selected from the group consisting of L, W, V, A, M, T, and S;

X₁₂ is selected from the group consisting of T, F, V, R, A, D, L, E, S,and Y;

X₁₃ is selected from the group consisting of I, M, G, Q, D, and R;

X₁₄ is selected from the group consisting of G, W, Y, L, M, and H;

X₁₅ is selected from the group consisting of N, P, F, H, K, and Y;

X₁₆ is selected from the group consisting of M, D, E, V, G, and K;

X₁₇ is selected from the group consisting of G, I, R, S, T, and L;

X₁₈ is selected from the group consisting of M, K, L, and I;

X₁₉ is selected from the group consisting of Y, G, R, and S;

X₂₀ is selected from the group consisting of A, E, S, C, and Y; and

X₂₁ is selected from the group consisting of A, V, K, and E.

In one aspect, the peptide comprises one or more N-terminal aminoacid(s) directly linked to X₇, wherein the N-terminal amino acid(s)comprise the amino acid sequence selected from the group consisting of

X₆,

X₅X₆,

X₄X₅X₆,

X₃X₄X₅X₆ (SEQ ID NO: 3110),

X₂X₃X₄X₅X₆ (SEQ ID NO: 3111), and

X₁X₂X₃X₄X₅X₆ (SEQ ID NO: 3112), wherein

X₁ is selected from the group consisting of T and G; X₂ is selected fromthe group consisting of F and V; X₃ is selected from the groupconsisting of V, W, Y, and F; X₄ is selected from the group consistingof D, Q, and S; X₅ is selected from the group consisting of E, T, N, andS; and X₆ is selected from the group consisting of R, H, K, and A.

Alternatively or in addition, the peptide comprises one or moreC-terminal amino acids directly linked to X₂₁, wherein the C-terminalamino acid(s) comprise the amino acid sequence selected from the groupconsisting of

X₂₂,

X₂₂X₂₃,

X₂₂X₂₃X₂₄,

X₂₂X₂₃X₂₄X₂₅ (SEQ ID NO: 3113),

X₂₂X₂₃X₂₄X₂₅X₂₆ (SEQ ID NO: 3114), and

X₂₂X₂₃X₂₄X₂₅X₂₆X₂₇ (SEQ ID NO: 3115), wherein

X₂₂ is selected from the group consisting of Q, I, E, W, R, L, and N;X₂₃ is selected from the group consisting of L, V, M, and R; X₂₄ isselected from the group consisting of K, L, A, and Y; X₂₅ is F; X₂₆ isG; and X₂₇ is T.

In one aspect, the invention provides a peptide comprising the aminoacid sequence set forth in SEQ ID NOs: 1-7, such as a peptide comprisingthe amino acid sequence set forth in any one of JBT0132, JBT0303,JBT0193, JBT0178, JBT0120, and JBT0224, which inhibits TFPI activitywithin the blood coagulation cascade. The invention also provides apeptide that binds TFPI comprising an amino acid sequence of at least60% identity to the sequencePhe-Gln-Ser-Lys-Gly-Asn-Val-Phe-Val-Asp-Gly-Tyr-Phe-Glu-Arg-Leu-Arg-AlaLys-Leu(FQSKGNVFVDGYFERLRAKL) (SEQ ID NO: 32).

In addition, the invention provides a peptide that binds TFPI, whereinthe peptide comprises the structure of formula (I):X1001-X1002-X1003-X1004-X1005-X1006-X1007-X1008-X1009-X1010-X1011-X1012-X1013-X1014-X1015-X1016-X1017-X1018-X1019-X1020(SEQ ID NO: 3116). In formula (I),

X1001 is an amino acid selected from the group consisting of Bhf, C, D,F, G, H, I, K, L, M, N, Nmf, Q, R, T, V, W and Y;

X1002 is an amino acid selected from the group consisting of G, K and Q;

X1003 is an amino acid selected from the group consisting of A, Aib,Bhs, C, D, E, F, G, H, I, K, L, M, N, P, Q, R, S, T, V, W and Y;

X1004 is an amino acid selected from the group consisting of A, Aib,Bhk, C, D, E, F, G, H, I, K, k, L, M, N, Nmk, P, Q, R, S, T, V, W and Y;

X1005 is an amino acid selected from the group consisting of a, A, Aib,Bal, C, D, d, E, F, G, H, K, k, L, M, N, Nmg, p, Q, R, S, T, V, W and Y;

X1006 is an amino acid selected from the group consisting of A, Aib,Btq, C, D, E, F, G, H, I, K, L, M, N, Q, R, S T, V, W and Y;

X1007 is an amino acid selected from the group consisting of A, F, G, I,K, L, Nmv, P, Q, S, V, W and Y;

X1008 is an amino acid selected from the group consisting of F, H, K, Wand Y;

X1009 is an amino acid selected from the group consisting of A, Aib, f,I, K, S, T and V;

X1010 is an amino acid selected from the group consisting of A, Aib, C,D, E, F, G, H, I, K, L, M, N, Nmf, P, Q, R, S, T, V, W and Y;

X1011 is an amino acid selected from the group consisting of Aib, C, K,G and Nmg;

X1012 is Y;

X1013 is an amino acid selected from the group consisting of A, Aib, C,E, F, G, H, K, L, M, Q, R, W and Y;

X1014 is an amino acid selected from the group consisting of A, Aib,Bhe, C, D, E, F, G, H, I, K, L, M, N, P, Q, R, S, T, V, W and Y;

X1015 is an amino acid selected from the group consisting of(omega-methyl)-R, D, E, K and R;

X1016 is L;

X1017 is an amino acid selected from the group consisting of(omega-methyl)-R, A, Aib, Bhr, C, Cha, Cit, D, Dab, Dap, E, Eag, Eew, F,G, H, Har, Hci, Hle, I, K, L, M, N, Nle, Nva, Opa, Orn, Q, R, S, T, V, Wand Y;

X1018 is an amino acid selected from the group consisting of A, Bal, C,D, E, F, G, H, I, K, L, M, N, Q, R, S, T, V, W and Y;

X1019 is an amino acid selected from the group consisting of Bhk, K, Rand V; and

X1020 is either present or absent, whereby, in case X1020 is present, itis an amino acid selected from the group consisting of Aib, Bhl, C, F,G, H, I, K, L, Nml, Q, R, S, T, V, W and Y.

In one aspect, the peptide that binds TFPI comprises the structure offormula (III):X1001-Q-X1003-X1004-X1005-X1006-I/V-X1008-V-X1010-G-Y—C/F-X1014-R-L-X1017-X1018-K-K/L(III) (SEQ ID NO: 3117). In formula (III), X1001, X1003, X1004, X1005,X1006, X1008, X1010, X1014, X1017 and X1018 are each independentlyselected from any amino acid.

The invention further provides a TFPI-binding peptide comprising thestructure of formula (V):X2001-X2002-X2003-X2004-X2005-X2006-[X2007-X2008-X2009-X2010-X2011-X2012-X2013-X2014-X2015-X2016-X2017-X2018]-X2019-X2020-X2021-X2022-X2023(V) (SEQ ID NO: 3118). In formula (V), X2001, X2002, and X2023independently are either present or absent. When present, X2001 is anamino acid selected from the group ° consisting of A, D, E, F, G, H, I,K, L, P, R, S, T, V and W; and X2002 is an amino acid selected from thegroup consisting of A, D, E, F, G, H, I, K, L, M, P, R, S, T, V and W.Additionally,

X2003 is an amino acid selected from the group consisting of A, F, I, K,L, R, S, T, V, W and Y;

X2004 is an amino acid selected from the group consisting of A, D, E, F,G, I, K, L, R, S, T, V and W;

X2005 is W;

X2006 is an amino acid selected from the group consisting of F, H, I, K,L, R V and W;

X2007 is an amino acid selected from the group consisting of C, Hcy, Dapand K, preferably selected from the group consisting of C and Hcy;

X2008 is an amino acid selected from the group consisting of A, G, R, Sand T;

X2009 is an amino acid selected from the group consisting of a, A, I, K,L, M, m, Nle, p, R, and V;

X2010 is an amino acid selected from the group consisting of A, G, I, K,L, P, R, S, T and V;

X2011 is an amino acid selected from the group consisting of D, E, G, Sand T;

X2012 is an amino acid selected from the group consisting of A, a, D, d,E, e, F, f, G, I, K, k, L, l, M, m, Nle, nle, P, p, R, r, S, s, T, t, V,v, W and w;

X2013 is an amino acid selected from the group consisting of A, D, d, E,e, F, G, I, K, L, R, S, s, T, V and W;

X2014 is an amino acid selected from the group consisting of A, D, E, F,G, I, K, L, M, R, S, T, V and W;

X2015 is an amino acid selected from the group consisting of A, D, E, F,G, I, K, L, M, Nle, R, S, T, V and W;

X2016 is an amino acid selected from the group consisting of A, D, E, F,I, K, L, M, Nle, R, S, T, V, W and Y;

X2017 is an amino acid selected from the group consisting of A, D, E, F,G, I, K, L, R, S, T, V, W and Y;

X2018 is an amino acid selected from the group consisting of C and D(preferably X2018 is C);

X2019 is an amino acid selected from the group consisting of A, F, I, L,S, T, V and W;

X2020 is an amino acid selected from the group consisting of F and W;

X2021 is an amino acid selected from the group consisting of I, L and V;and

X2022 is an amino acid selected from the group consisting of A, D, E, F,G, I, K, L, P, R, S, T, V, and W.

When X2023 is present in the peptide, X2023 is an amino acid selectedfrom the group consisting of A, D, E, F, G, I, K, L, R, S, T, V, W andY. The peptide comprises a cyclic structure generated by a linkagebetween X2007 and X2018, indicated in Formula (V) by brackets.

The invention also provides a peptide that binds TFPI, wherein thepeptide comprises the structure of formula (VI):X2001-X2002-F/Y-K-W-F/H-[C—X2008-M/V-X2010-D-X2012-X2013-G-I/T-X2016-S/T-C]-A/V-W-V-X2022-X2023(VI) (SEQ ID NO: 3119). In formula (VI), X2001, X2002 and X2023 are eachindependently present or absent. X2008, X2010, X2012, X2013, X2016 andX2022, as well as X2001, X2002, and X2023 when present, are eachindependently selected from any amino acid. The peptide comprises acyclic structure generated by a linkage between X2007 and X2018,indicated in Formula (VI) by brackets.

In one aspect, the invention provides a peptide that binds TFPI, whereinthe peptide comprises the structure of formula (VIII):X3001-X3002-X3003-X3004-X3005-X3006-X3007-X3008-X3009-X3010-X3011-X3012-X3013-X3014-X3015-X3016-X3017-X3018-X3019-X3020-X3021(VIII) (SEQ ID NO: 3120). In formula (VIII), X3001 and X3002 are eachindependently present or absent. When present, X3001 is an amino acidselected from the group consisting of A, C, D, F, G, I, K, L, M, N, P,Q, R, S, T, W, E, H and Y; and X3002 is an amino acid selected from thegroup consisting of A, C, D, F, H, K, M, N, P, R, S, T, W, Y, G, I andL. With respect to the remainder of formula (VIII),

X3003 is an amino acid selected from the group consisting of A, C, D, E,F, G, H, I, K, L, M, N, P, Q, R, S, T, W and Y;

X3004 is an amino acid selected from the group consisting of A, C, D, E,F, G, H, I, K, L, M, N, Q, R, S, T, V, W, Y and P;

X3005 is an amino acid selected from the group consisting of C, D, F, G,H, I, K, L, M, N, P, R, S, T, V, W and Y;

X3006 is an amino acid selected from the group consisting of A, W, C, K,P, R and H;

X3007 is an amino acid selected from the group consisting of Q, A, C, F,G, H, I, K, L, N, R, S, T, W and Y;

X3008 is an amino acid selected from the group consisting of A, C, F, G,H, K, L, M, N, P, Q, R, S, T, V, W, Y and I;

X3009 is an amino acid selected from the group consisting of A, C, F, G,H, I, L, M, R, S, T, V, W, Y and K;

X3010 is an amino acid selected from the group consisting of A, C, F, G,H, I, K, L, M, N, P, Q, R, S, T, V, W and Y;

X3011 is an amino acid selected from the group consisting of A, G, I, K,L, M, N, Q, R, S, T, V, W, Y, C, F and H;

X3012 is an amino acid selected from the group consisting of A, C, H, I,K, L and R;

X3013 is an amino acid selected from the group consisting of A, C, F, G,H, K, L, M, R, S, V, W, Y and I;

X3014 is an amino acid selected from the group consisting of A, C, F, G,H, I, L, M, N, Q, R, S, T, V, W, Y and K;

X3015 is an amino acid selected from the group consisting of A, K and R;

X3016 is an amino acid selected from the group consisting of A, F, K andR;

X3017 is an amino acid selected from the group consisting of A, C, F, G,I, K, L, N, Q, R, S, T, V, W, Y, H, A and M;

X3018 is an amino acid selected from the group consisting of A, C, F, I,K, L, M, Q, R, V, W and Y;

X3019 is an amino acid selected from the group consisting of A, C, D, E,F, G, H, K, L, N, P, Q, R, V, W, Y and I;

X3020 is an amino acid selected from the group consisting of A, C, F, G,H, K, L, M, N, Q, R, V, W, Y, I and P; and

X3021 is an amino acid selected from the group consisting of A, C, H, I,K, L, M, N, P, Q, R, T, V, W, Y, F and G.

Additionally, the invention provides a TFPT-binding peptide comprisingthe structure of formula (IX):X3001-X3002-X3003-X3004-X3005-X3006-X3007-X3008-X3009-X3010-X3011-H—X3013-X3014-K/R—R—X3017-X3018-X3019-X3020-X3021(IX) (SEQ ID NO: 3121), wherein X3001, X3002, X3003, X3004, X3005,X3006, X3007, X3008, X3009, X3010, X3011, X3013, X3014, X3017, X3018,X3019, X3020 and X3021 are each independently selected from any aminoacid. In addition, the invention includes a peptide that binds TFPI,wherein the peptide comprises an amino acid sequence having at least 60%identity to the sequence of formula (X): Ac-GYASFPWFVQLHVHKRSWEMA-NH2(SEQ ID NO: 223). In the context of the disclosure, any peptideencompassed by any of formulas (I) to (X) and any TFPI-binding peptidedescribed herein is also referred to as “the peptide of the invention”and as “a peptide as described herein.”

In some embodiments, the peptide of the invention binds TFPI-1 (e.g.,TFPI-1α) and, optionally, improves TFPI-regulated thrombin generation inthe absence of FVIII, FIX, and/or FXI. A composition (e.g., apharmaceutical composition) comprising the peptide also is provided.

In addition, the invention provides methods of using the peptide of theinvention. For example, the invention provides a method of inhibiting aTFPI comprising contacting the TFPI with a peptide as described herein.The invention also provides a method of enhancing thrombin formation ina clotting factor-deficient subject, a method for increasing blood clotformation in a subject, and a method of treating a blood coagulationdisorder in a subject. The methods are, in their entirety, also referredto herein as, e.g., “the method of the invention.” The methods compriseadministering to the subject a peptide as provided herein in an amounteffective to enhance thrombin formation, an amount effective to enhanceblood clot formation, or an amount effective to treat the bloodcoagulation disorder in the subject. Unless explicitly indicated to thecontrary, the description provided herein with respect to one peptide ofthe invention or method of the invention applies to each and everypeptide of the invention and method of the invention, respectively.Further aspects of the invention include use of the peptide of theinvention for the manufacture of a medicament, a method for targeting acell displaying TFPI, a method for treating or diagnosing a subjectsuffering from a disease or at risk of suffering from a disease, and amethod of purifying TFPI. The preceding methods are, in their entirety,also referred to herein as, e.g., “the method of the invention.”

DESCRIPTION OF THE FIGURES

FIG. 1 is an illustration of the blood coagulation cascade.

FIG. 2 is an illustration of the secondary structure of Tissue FactorPathway Inhibitor-1.

FIG. 3 is an illustration of the formation of a quaternary complexcomprising Tissue Factor, Factor Xa (FXa), Factor VIIa (FVIIa), andTFPI.

FIG. 4 is a listing of amino acid sequences of various TFPI-inhibitorypeptides denoting amino acid substitutions (bolded and underlined) inreference to peptide JBT0293.

FIG. 5 is an illustration of mRNA display selection of TFPI-inhibitorpeptides.

FIG. 6A is an illustration of the EC₅₀ binding ELISA and FIG. 6B is anillustration of the IC₅₀ ELISA described in Example 1.

FIG. 7 is a binding ELISA curve comparing % OD (y-axis) andconcentration [nM] (x-axis) for biotinylated peptide JBT0132.

FIGS. 8A-8D are competition ELISA curves comparing % OD (y-axis) andconcentration [nM] (x-axis) for exemplary peptides of the invention.

FIGS. 9A and 9B are sensorgrams plotting RU (y-axis) against time inseconds (x-axis) for peptides JBT0120 and JBT0132.

FIGS. 10A and 10B are sensorgrams plotting RU (y-axis) against time inseconds (x-axis) for peptide JBT0120 interaction with Tissue FactorPathway Inhibitor-1 and Tissue Factor Pathway Inhibitor-2.

FIGS. 11A and 11B are graphs comparing amount of thrombin generated (nM)(y-axis) and time in minutes (x-axis) for peptide JBT0120 and peptideJBT0132 in a plasma-based assay.

FIGS. 12A-L, 13A-D, 14A-D, 15A-C, 16A-E, 17A-B, and 18A-D are tableslisting the amino acid sequences of various TFPI-inhibitory peptides;EC₅₀ and percent inhibition of TFPI observed in the FXa inhibitionassay; EC₅₀ and percent inhibition of TFPI observed in the extrinsictenase inhibition assay; and FEIBA, Factor VIII (FVIII) Immunate, orFactor IX (FIX) equivalent activities (mU/mL) in plasma-based assays.“*” denotes negative controls.

FIGS. 19A-B, 20 and 21 are tables listing the results from BIAcoreanalysis of several TFPI-binding peptides. “*” denotes negativecontrols.

FIGS. 22A-J, 23A-J, 24A-C, 25A-J, 26A-E, 27A-C, 28A-H, 29A-D and 30A-Care tables listing the amino acid sequences of various TFPI-bindingpeptides; EC₅₀ and percent inhibition of TFPI observed in the FXainhibition assay; EC₅₀ and percent inhibition of TFPI observed in theextrinsic tenase inhibition assay; and FEIBA, FVIII Immunate, or FIXequivalent activities (mU/mL) in plasma-based assays. “*” denotesnegative controls.

FIG. 31 is a graph comparing a pharmacokinetic characteristic(concentration of peptide (y-axis) versus time after administration(x-axis)) of a PEGylated TFPI-binding peptide to the pharmacokineticcharacteristic of same peptide lacking PEG. The peptides wereadministered intravenously to C57B16 mice at a dose of 10 mg/kg. Threebiological samples were analyzed for the presence of peptide at eachtime point.

FIGS. 32A-MM, 33, 34A-J, 35, 36A-Q, 37, 38A-B and 39 are tables listingthe amino acid sequences and IC₅₀ or EC₅₀ values of various peptides ofthe invention. “*” denotes negative controls.

DETAILED DESCRIPTION OF THE INVENTION

The invention provides peptides that block the inhibitory activity ofTissue Factor Pathway Inhibitor-1 (herein referred to as TFPI) withinthe blood coagulation cascade. Upon vascular injury, Tissue Factor (TF)complexes with Factor Vlla to form the “extrinsic complex” or “extrinsictenase complex,” which activates Factors IX and X (FIG. 1). TFPI is themain natural regulator of TF/FVIIa extrinsic complex activity and byextension, plays a role in controlling thrombin generation (Panteleev etal., Eur. J. Biochem., 249, 2016-2031 (2002)). TFPI is a 43 kDa serineprotease inhibitor comprising three Kunitz-type inhibitory domains (FIG.2). Kunitz domain 1 of TFPI binds FVIIa and Kunitz domain 2 binds FXa,enabling the inhibitor to form a quaternary FXa-TFPI-FVIIa-TF complexthat blocks activity of the TF/FVIIa extrinsic complex (FIG. 3). TFPIbinding of FXa also downregulates the common pathway of the coagulationcascade, during which FXa converts prothrombin to thrombin (Audu et al.,Anesth. Analg., 103(4), 841-845 (2006)). The invention provides, e.g.,TFPI-inhibitory peptides that block TFPI's inhibitory action on theblood coagulation cascade, thereby enhancing thrombin formation.

The amino acid sequences of several TFPI-binding peptides are providedherein. Conventional amino acids are identified according to theirstandard, one-letter or three-letter codes, as set forth in Table 1.

TABLE 1 3-letter 1-letter codes code Amino acids Ala A Alanine Cys CCysteine Asp D Aspartic acid Glu E Glutamic acid Phe F Phenylalanine GlyG Glycine His H Histidine Ile I Isoleucine Lys K Lysine Leu L LeucineMet M Methionine Asn N Asparagine Pro P Proline Gln Q Glutamine Arg RArginine Ser S Serine Thr T Threonine Val V Valine Trp W Tryptophan TyrY Tyrosine

Non-conventional amino acids and additional peptide building blocks areidentified according to a three-letter code (with the exception of Ttds,which is a common four-letter abbreviation) found in Table 2.

TABLE 2 Name Abbreviation Structure 2-aminobutyric acid Abu

2-Amino-isobutyric acid Aib

β-Alanine Bal

β-Homoglutamatic acid Bhe

β-Homophenylalanine Bhf

β-Homolysine Bhk

β-Homoleucine Bhl

β-Homoasparagine Bhn

β-Homoglutamine Bhq

β-Homoarginine Bhr

β-Homoserine Bhs

β-Homotyrosine Bhy

β-Homoaspartic acid Bhd

β-Homovaline Bhv, Btl

β-Homoasparagin Bhn, Btq

(S)-Cyclohexylalanine Cha

(S)-Citrullin Cit

(S)-2,4-Diaminobutyric acid Dab

(S)-Diaminopropionic acid Dap

(S)-2-Propargylglycine Eag

(S)-N(omega)-nitro-arginine Eew

L-homophenylalanine Hfe

(S)-Homo-arginine Har

(S)-Homo-citrulline Hci

(S)-Homo-cysteine Hcy

(S)-2-Amino-5-methyl-hexanoic acid Hle

(S)-Homo-lysine Hly

(S)-Norleucine Nle

(S)-N-Methylalanine Nma

(S)-N-Methyl-Aspartic acid Nmd

(S)-N-Methyl-glutamic acid Nme

(S)-N-Methyl-phenylalanine Nmf

N-Methyl-glycine Nmg

(S)-N-Methyl-lysine Nmk

(S)-N-Methyl-leucine Nml

(S)-N-Methyl-arginine Nmr

(S)-N-Methyl-serine Nms

(S)-N-Methyl-valine Nmv

(S)-N-Methyl-tyrosine Nmy

(S)-2-Amino-pentanoic acid Nva

(S)-2-Pyridyl-alanine Opa

(S)-Ornithine Orn

L-phenylglycin Phg

4-Phenyl-butyric acid PhPrCO

Polyethylene glycol PEG Selenomethionine Sem

1,2,3,4-L- tetrahydroisoquinolinecarboxylic acid Tic

(13-Amino-4,7,10-trioxa- tridecayl)-succinamic acid Ttds

Carboxyfluorescein FAM

The amino acid sequences of the peptides provided herein are depicted intypical peptide sequence format, as would be understood by the ordinaryskilled artisan. For example, the three-letter code or one-letter codeof a conventional amino acid, or the three-letter code or abbreviationfor a non-conventional amino acid, indicates the presence of the aminoacid in a specified position within the peptide sequence. The code foreach non-conventional amino acid is connected to the code for the nextand/or previous amino acid in the sequence by a hyphen. Adjacent aminoacids are connected by a chemical bond (typically an amide bond). Theformation of the chemical bond removes a hydroxyl group from the1-carboxyl group of the amino acid when it is located to the left of theadjacent amino acid (e.g., Hle-adjacent amino acid), and removes ahydrogen from the amino group of the amino acid when it is located onthe right of the adjacent amino acid (e.g., adjacent amino acid-Hle). Itis understood that both modifications can apply to the same amino acidand apply to adjacent conventional amino acids present in amino acidsequences without hyphens explicitly illustrated. Where an amino acidcontains more than one amino and/or carboxy group in the amino acid sidechain, the 2- or 3-amino group and/or the 1-carboxy group generally areused for the formation of peptide bonds. For non-conventional aminoacids, a 3-letter code was used where the first letter indicates thestereochemistry of the C-α-atom. For example, a capital first letterindicates that the L-form of the amino acid is present in the peptidesequence, while a lower case first letter indicating that the D-form ofthe correspondent amino acid is present in the peptide sequence. Whenone-letter code is used, a lower case letter represents a D-amino acid,while an upper case letter represents an L-amino acid. Unless indicatedto the contrary, the amino acid sequences are presented herein in N- toC-terminus direction.

The C-termini of several TFPI-binding peptide sequences described hereinare explicitly illustrated by inclusion of an OH, NH₂, or anabbreviation for a specific terminating amine linked to the C-terminalamino acid code via a hyphen. The N-termini of several peptidesdescribed herein are explicitly illustrated by inclusion of a hydrogen(for a free N-terminus), or an abbreviation for a specific terminatingcarboxylic acid or other chemical group linked to the N-terminal aminoacid code via a hyphen.

The invention provides a peptide comprising the amino acid sequenceX₇X₈X₉X₁₀X₁₁X₁₂X₁₃X₁₄X₁₅X₁₆X₁₇X₁₈X₁₉X₂₀X₂₁ (SEQ ID NO: 3109), wherein(using single letter codes for amino acids)

X₇ is selected from the group consisting of L, P, K, S, W, V, N, and Q;

X₈ is selected from the group consisting of L, R, N, F, and I;

X₉ is selected from the group consisting of Y, V, P, and C;

X₁₀ is selected from the group consisting of F, L, and G;

X₁₁ is selected from the group consisting of L, W, V, A, M, T, and S;

X₁₂ is selected from the group consisting of T, F, V, R, A, D, L, E, S,and Y;

X₁₃ is selected from the group consisting of I, M, G, Q, D, and R;

X₁₄ is selected from the group consisting of G, W, Y, L, M, and H;

X₁₅ is selected from the group consisting of N, P, F, H, K, and Y;

X₁₆ is selected from the group consisting of M, D, E, V, G, and K;

X₁₇ is selected from the group consisting of G, I, R, S, T, and L;

X₁₈ is selected from the group consisting of M, K, L, and I;

X₁₉ is selected from the group consisting of Y, G, R, and S;

X₂₀ is selected from the group consisting of A, E, S, C, and Y; and

X₂₁ is selected from the group consisting of A, V, K, and E.

In addition to the core structure set forth above, X₇-X₂₁, otherstructures that are specifically contemplated are those in which one ormore additional amino acids are attached to the core structure (e.g.,linked to the N-terminus or the C-terminus of the amino acid sequenceX₇-X₂₁). Thus, the invention includes peptides comprising the corestructure and further comprising one or more N-terminal amino acid(s)comprising an amino acid sequence selected from the group consisting of:

X₆,

X₅X₆,

X₄X₅X₆,

X₃X₄X₅X₆ (SEQ ID NO: 3110),

X₂X₃X₄X₅X₆(SEQ ID NO: 3111), and

X₁X₂X₃X₄X₅X₆(SEQ ID NO: 3112);

wherein X₆ is directly linked to X₇ of the core structure amino acidsequence, and

X₁ is selected from the group consisting of T and G;

X₂ is selected from the group consisting of F and V;

X₃ is selected from the group consisting of V, W, Y, and F;

X₄ is selected from the group consisting of D, Q, and S;

X₅ is selected from the group consisting of E, T, N, and S; and

X₆ is selected from the group consisting of R, H, K, and A.

The peptide of the invention in one aspect comprises or consists of theamino acid sequence QSKKNVFVFGYFERLRAK (SEQ ID NO: 1).

In another embodiment, the peptide of the invention comprising the corestructure comprises one or more C-terminal amino acid(s) comprising anamino acid sequence selected from the group consisting of:

X₂₂,

X₂₂X₂₃,

X₂₂X₂₃X₂₄,

X₂₂X₂₃X₂₄X₂₅ (SEQ ID NO: 3113),

X₂₂X₂₃X₂₄X₂₅X₂₆ (SEQ ID NO: 3114), and

X₂₂X₂₃X₂₄X₂₅X₂₆X₂₇ (SEQ ID NO: 3115),

wherein X₂₂ is directly linked to X₂₁ of the core structure amino acidsequence, and

X₂₂ is selected from the group consisting of Q, I, E, W, R, L, and N;

X₂₃ is selected from the group consisting of L, V, M, and R;

X₂₄ is selected from the group consisting of K, L, A, and Y;

X₂₅ is F;

X₂₆ is G; and

X₂₇ is T.

In one aspect, the peptide of the invention comprises or consists of theamino acid sequence VIVFTFRHNKLIGYERRY (SEQ ID NO: 4). It is alsocontemplated that the peptide of the invention comprises additionalamino acids at both the N-terminus and the C-terminus of the corestructure. In this aspect, the peptide comprises or consists of theamino acid sequence TFVDERLLYFLTIGNMGMYAAQLKF (SEQ ID NO: 3),GVWQTHPRYFWTMWPDIKGEVIVLFGT (SEQ ID NO: 5), KWFCGMRDMKGTMSCVWVKF (SEQ IDNO: 6), or ASFPLAVQLHVSKRSKEMA (SEQ ID NO: 7).

The invention further includes peptides comprising the amino acidsequence X₃X₄X₅-F-X₇-NVF-X₁₁X₁₂-GY-X₁₅X₁₆-RLRAK-X₂₂ (SEQ ID NO: 2),wherein X₃ is Y or F; X₄ is Q or S; X₅ is N or S; X₇ is K, N, or Q; X₁₁is V, A, S, or T; X₁₂ is F, A, D, L, Q, S, or Y; X₁₅ is F, K, or Y; X₁₆is E or D; and X₂₂ is L or N.

In addition, the invention provides a peptide that binds TFPI, whereinthe peptide comprises the structure of formula (I):X1001-X1002-X1003-X1004-X1005-X1006-X1007-X1008-X1009-X1010-X1011-X1012-X1013-X1014-X1015-X1016-X1017-X1018-X1019-X1020(SEQ ID NO: 3116). In formula (I),

X1001 is an amino acid selected from the group consisting of Bhf, C, D,F, G, H, I, K, L, M, N, Nmf, Q, R, T, V, W and Y;

X1002 is an amino acid selected from the group consisting of G, K and Q;

X1003 is an amino acid selected from the group consisting of A, Aib,Bhs, C, D, E, F, G, H, I, K, L, M, N, P, Q, R, S, T, V, W and Y;

X1004 is an amino acid selected from the group consisting of, A, Aib,Bhk, C, D, E, F, G, H, I, K, k, L, M, N, Nmk, P, Q, R, S, T, V, W and Y;

X1005 is an amino acid selected from the group consisting of a, A, Aib,Bal, C, D, d, E, F, G, H, K, k, L, M, N, Nmg, p, Q, R, S, T, V, W and Y;

X1006 is an amino acid selected from the group consisting of A, Aib,Btq, C, D, E, F, G, H, I, K, L, M, N, Q, R, S T, V, W and Y;

X1007 is an amino acid selected from the group consisting of A, F, G, I,K, L, Nmv, P, Q, S, V, W and Y;

X1008 is an amino acid selected from the group consisting of F, H, K, Wand Y;

X1009 is an amino acid selected from the group consisting of A, Aib, f,I, K, S, T and

V;

X1010 is an amino acid selected from the group consisting of A, Aib, C,D, E, F, G, H, I, K, L, M, N, Nmf, P, Q, R, S, T, V, W and Y;

X1011 is an amino acid selected from the group consisting of Aib, C, K,G and Nmg;

X1012 is Y;

X1013 is an amino acid selected from the group consisting of A, Aib, C,E, F, G, H, K, L, M, Q, R, W and Y;

X1014 is an amino acid selected from the group consisting of A, Aib,Bhe, C, D, E, F, G, H, I, K, L, M, N, P, Q, R, S, T, V, W and Y;

X1015 is an amino acid selected from the group consisting of(omega-methyl)-R, D, E, K and R;

X1016 is L;

X1017 is an amino acid selected from the group consisting of(omega-methyl)-R, A, Aib, Bhr, C, Cha, Cit, D, Dab, Dap, E, Eag, Eew, F,G, H, Har, Hci, Hle, I, K, L, M, N, Nle, Nva, Opa, Orn, Q, R, S, T, V, Wand Y;

X1018 is an amino acid selected from the group consisting of A, Bal, C,D, E, F, G, H, I, K, L, M, N, Q, R, S, T, V, W and Y; and

X1019 is an amino acid selected from the group consisting of Bhk, K, Rand V.

X1020 is either present or absent in formula (I) (i.e., in someinstances, the peptide of the invention comprises the structureX1001-X1002-X1003-X1004-X1005-X1006-X1007-X1008-X1010-X1011-X1012-X1013-X1014-X1015-X1016-X1017-X1018-X1019(SEQ ID NO: 3116)). When X1020 is present, it is an amino acid selectedfrom the group consisting of Aib, Bhl, C, F, G, H, I, K, L, Nml, Q, R,S, T, V, W and Y.

For example, the peptide of the invention comprises the structure offormula (I) wherein X1001 is an amino acid selected from the groupconsisting of C, F, I, K, L, Nmf, V, M, W and Y; X1002 is Q; X1003 is anamino acid selected from the group consisting of A, C, D, E, H, K, M, I,N, Q, R, S, T and V; X1004 is an amino acid selected from the groupconsisting of A, Aib, C, D, E, G, H, F, I, K, k, L, M, N, Nmk, P, Q, R,S, V, W and Y; X1005 is an amino acid selected from the group consistingof a, A, Aib, Bal, C, d, E, D, F, G, H, K, k, L, M, N, Nmg, p, Q, R, S,T and Y; X1006 is an amino acid selected from the group consisting of A,Btq, C, D, G, I, K, H, L, M, N, Q, R, S, V and Y; X1007 is an amino acidselected from the group consisting of I, K, L, Q, V and Y; X1008 is anamino acid selected from the group consisting of F, H and Y; X1009 is anamino acid selected from the group consisting of f, I and V; X1010 is anamino acid selected from the group consisting of A, D, E, F, G, H, K, L,M, N, P, Q, R, S, T, V, W and Y; X1011 is an amino acid selected fromthe group consisting of G and Nmg; X1012 is Y; X1013 is an amino acidselected from the group consisting of Aib, C, F, H, L, W and Y; X1014 isan amino acid selected from the group consisting of A, Aib, Bhe, C, D,E, H, I, K, L, M, N, Q, R, S, T, V, W and Y; X1015 is an amino acidselected from the group consisting of E and R; X1016 is L; X1017 is anamino acid selected from the group consisting of (omega-methyl)-R, A,Aib, Bhr, C, Cha, Cit, Dab, Dap, Eag, Eew, F, H, Har, Hci, Hle, I, K, L,M, N, Nle, Nva, Opa, Orn, R, S, T, V and Y; X1018 is an amino acidselected from the group consisting of A, C, D, E, F, I, K, L, M, N, Q,R, V and W; X1019 is an amino acid selected from the group consisting ofK and R; and X1020 is an amino acid selected from the group consistingof Aib, Bhl, F, K, L, R and W (when X1020 is present in the peptide).

In one aspect, the peptide of the invention comprises the structure offormula (I) wherein X1001 is an amino acid selected from the groupconsisting of F, L, Y and M; X1002 is Q; X1003 is an amino acid selectedfrom the group consisting of M, Q, R, S, T and C; X1004 is an amino acidselected from the group consisting of Aib, K, L, P, R, E, G, I, Y, M andW; X1005 is an amino acid selected from the group consisting of a, Aib,D, d, G, H, K, k, N, Nmg, p, Q, R, A, E, C and M; X1006 is an amino acidselected from the group consisting of A, C, D, G, H, K, N, Q, R, S andM; X1007 is an amino acid selected from the group consisting of I and V;X1008 is an amino acid selected from the group consisting of F, H and Y;X1009 is V; X1010 is an amino acid selected from the group consisting ofA, D, E, K, M, N, Q, R, F, H, P, S, V, W and Y; X1011 is G; X1012 is Y;X1013 is C or F; X1014 is an amino acid selected from the groupconsisting of A, C, D, E, K, L, M, N, Q, R, T, V and Aib; X1015 is R;X1016 is L; X1017 is an amino acid selected from the group consisting ofA, Aib, C, Cha, Dab, Dap, Eag, Eew, H, Har, Hci, Hle, K, Nle, Nva, Opa,Orn, R, I, L, S and M; X1018 is an amino acid selected from the groupconsisting of A, L, N, M and R; X1019 is K; and X1020 is K or L.

When amino acid X1020 is absent from formula (I), the peptide of theinvention in one aspect further comprises amino acid X1000 at theN-terminus of formula (I), such that the peptide comprises or consistsof the structure of formula (II):X1000-X1001-X1002-X1003-X1004-X1005-X1006-X1007-X1008-X1009-X1010-X1011-X1012-X1013-X1014-X1015-X1016-X1017-X1018-X1019(II) (SEQ ID NO: 3122). When X1000 is present in the peptide, X1000 isan amino acid selected from the group consisting of A, E, and P, whilethe amino acids of X1001-X1019 are as defined above.

In an additional aspect, the TFPI-binding peptide of the inventioncomprises the structure of formula (III):X1001-Q-X1003-X1004-X1005-X1006-I/V-X1008-V-X1010-G-Y-C/F-X1014-R-L-X1017-X1018-K-K/L(III) (SEQ ID NO: 3117). X1001, X1003, X1004, X1005, X1006, X1008,X1010, X1014, X1017 and X1018 in formula (III) are each independentlyselected from any amino acid. For example, in formula (III),

X1001 is optionally an amino acid selected from the group consisting ofBhf, C, D, F, G, H, I, K, L, M, N, Nmf, Q, R, T, V, W and Y, such as anamino acid selected from the group consisting of C, F, I, K, L, Nmf, V,M, W and Y (e.g., an amino acid selected from the group consisting of F,L, Y and M);

X1003 is optionally an amino acid selected from the group consisting ofA, Aib, Bhs, C, D, E, F, G, H, I, K, L, M, N, P, Q, R, S, T, V, W and Y,such as an amino acid selected from the group consisting of A, C, D, E,H, K, M, I, N, Q, R, S, T and V (e.g., the amino acid is M, Q, R, S, Tor C);

X1004 is optionally an amino acid selected from the group consisting of,A, Aib, Bhk, C, D, E, F, G, H, I, K, k, L, M, N, Nmk, P, Q, R, S, T, V,W and Y, such as an amino acid selected from the group consisting of A,Aib, C, D, E, G, H, F, I, K, k, L, M, N, Nmk, P, Q, R, S, V, W and Y(e.g., an amino acid selected from the group consisting of Aib, K, L, P,R, E, G, I, Y, M and W);

X1005 is optionally an amino acid selected from the group consisting ofa, A, Aib, Bal, C, D, d, E, F, G, H, K, k, L, M, N, Nmg, p, Q, R, S, T,V, W and Y, such as an amino acid selected from the group consisting ofa, A, Aib, Bal, C, d, E, D, F, G, H, K, k, L, M, N, Nmg, p, Q, R, S, Tand Y (e.g., the amino acid is a, Aib, D, d, G, H, K, k, N, Nmg, p, Q,R, A, E, C or M);

X1006 is optionally an amino acid selected from the group consisting ofA, Aib, Btq, C, D, E, F, G, H, I, K, L, M, N, Q, R, S, T, V, W and Y,such as an amino acid selected from the group consisting of A, Btq, C,D, G, I, K, H, L, M, N, Q, R, S, V and Y (e.g., an amino acid selectedfrom the group consisting of A, C, D, G, H, K, N, Q, R, S and M);

X1008 is optionally an amino acid selected from the group consisting ofF, H, K, W and Y, such as an amino acid selected from the groupconsisting of F, H and Y;

X1010 is optionally an amino acid selected from the group consisting ofA, Aib, C, D, E, F, G, H, I, K, L, M, N, Nmf, P, Q, R, S, T, V, W and Y,such as an amino acid selected from the group consisting of A, D, E, F,G, H, K, L, M, N, P, Q, R, S, T, V, W and Y (e.g., an amino acidselected from the group consisting of A, D, E, K, M, N, Q, R, F, H, P,S, V, W and Y);

X1014 is optionally an amino acid selected from the group consisting ofA, Aib, Bhe, C, D, E, F, G, H, I, K, L, M, N, P, Q, R, S, T, V, W and Y,such as an amino acid selected from the group consisting of A, Aib, Bhe,C, D, E, H, I, K, L, M, N, Q, R, S, T, V, W and Y (e.g., A, C, D, E, K,L, M, N, Q, R, T, V or Aib);

X1017 is optionally an amino acid selected from the group consisting of(omega-methyl)-R, A, Aib, Bhr, C, Cha, Cit, D, Dab, Dap, E, Eag, Eew, F,G, H, Har, Hci, Hle, I, K, L, M, N, Nle, Nva, Opa, Orn, Q, R, S, T, V, Wand Y, such as an amino acid selected from the group consisting of(omega-methyl)-R, A, Aib, Bhr, C, Cha, Cit, Dab, Dap, Eag, Eew, F, H,Har, Hci, Hle, I, K, L, M, N, Nle, Nva, Opa, Orn, R, S, T, V and Y(e.g., an amino acid selected from the group consisting of A, Aib, C,Cha, Dab, Dap, Eag, Eew, H, Har, Hci, Hle, K, Nle, Nva, Opa, Orn, R, I,L, S and M); and/or

X1018 is optionally an amino acid selected from the group consisting ofA, Bal, C, D, E, F, G, H, I, K, L, M, N, Q, R, S, T, V, W and Y, such asan amino acid selected from the group consisting of A, C, D, E, F, I, K,L, M, N, Q, R, V and W (e.g., an amino acid selected from the groupconsisting of A, L, N, M and R).

In some embodiments, the peptide of the invention comprises one or moreadditional amino acid residues attached to the N- or C-terminus of theamino acid sequence. For example, the peptide comprising the structureof any one of formulas (I)-(III), in some embodiments, further comprisesone or more N-terminal amino acid(s) directly linked to X1001, whereinthe N-terminal amino acid(s) comprise the amino acid sequence selectedfrom the group consisting of

X1000,

X999-X1000,

X998-X999-X1000,

X997-X998-X999-X1000 (SEQ ID NO: 3123),

X996-X997-X998-X999-X1000 (SEQ ID NO: 3124),

X995-X996-X997-X998-X999-X1000 (SEQ ID NO: 3125),

X994-X995-X996-X997-X998-X999-X1000 (SEQ ID NO: 3126),

X993-X994-X995-X996-X997-X998-X999-X1000 (SEQ ID NO: 3127),

X992-X993-X994-X995-X996-X997-X998-X999-X1000 (SEQ ID NO: 3128),

X991-X992-X993-X994-X995-X996-X997-X998-X999-X1000 (SEQ ID NO: 3129),and

X990-X991-X992-X993-X994-X995-X996-X997-X998-X999-X1000 (SEQ ID NO:3130).

When the peptide comprises one or more N-terminal amino acids, X1000 isA or K; X999 is V or K; X998 is Q or K; X997 is L or K; X996 is R or K;X995 is G or K; X994 is V or K; X993 is G or K; X992 is S or K; X991 isK; and X990 is K.

In addition to the core structures set forth in formulas (I)-(III),other structures that are specifically contemplated are those in whichone or more additional amino acids are attached to the C-terminus of thecore structure directly linked to X1020. For example, the C-terminaladdition optionally comprises an amino acid sequence selected from thegroup consisting of X1021, X1021-X1022, X1021-X1022-X1023, andX1021-X1022-X1023-X1024 (SEQ ID NO: 3131), wherein X1021 is T or K;X1022 is S or K; and X1023 and X1024 are K.

The invention further includes a TFPI-binding peptide comprising orconsisting of an amino acid sequence having at least 60% identity (e.g.,at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, atleast 90%, at least 95% or 100% identity) to the amino acid sequenceAc-FQSK-Nmg-NVFVDGYFERL-Aib-AKL-NH2 (formula IV) (SEQ ID NO: 164). Insome instances, the peptide comprises or consists of the amino acidsequence of any one of formulas (I)-(III), as described herein. Theinvention also includes a peptide comprising or consisting of an aminoacid sequence selected from the group consisting of SEQ ID NOs: 8-978(e.g., a peptide comprising or consisting of the amino acid sequenceselected from the group consisting of SEQ ID NOs: 8-741 and 962-972(such as SEQ ID NOs: 8-741, 962-968, 971, or 972) and/or selected fromthe group consisting of 742-961 (such as SEQ ID NOs: 744-961) and/orselected from the group consisting of SEQ ID NOs: 973-978).

The peptides of the invention, in some instances, compriseintramolecular disulfide bonds. In this regard, the peptide comprisingthe structure of formulas (I)-(III) contains at least two cysteineresidues (e.g., the peptide contains two cysteine residues) that arespaced apart by at least three amino acid residues such that thecysteines form an intramolecular disulfide bond. In some instances, thecysteines are spaced apart by more than three amino acid residues. Forexample, in the peptide comprising the structure of formulas (I), (II),or (III), any two of X1000, X1001, X1003, X1004, X1005, X1006, X1010,X1011, X1013, X1014, X1017, X1018, X1020 and X1021 are optionallycysteines capable of forming a disulfide bridge. Accordingly, in someaspects, the peptide contains two cysteine residues: one of X1000,X1005, X1010 and X1014 is cysteine, and one of X1006, X1010, X1017 andX1021 is a cysteine. The invention contemplates all of the possiblecombinations of cysteine pairs, e.g., X1000 and X1006 are C; X1000 andX1010 are C; X1000 and X1017 are C; X1005 and X1017 are C; X1010 andX1017 are C; X1010 and X1021 are C; or X1014 and X1021 are C.

The invention further provides a peptide that binds TFPI, the peptidecomprising the structure of formula (V):X2001-X2002-X2003-X2004-X2005-X2006-[X2007-X2008-X2009-X2010-X2011-X2012-X2013-X2014-X2015-X2016-X2017-X2018]-X2019-X2020-X2021-X2022-X2023(V) (SEQ ID NO: 3118), wherein the peptide forms a cyclic structuregenerated by a linkage, e.g., a disulfide bond, between X2007 and X2018(denoted as brackets within formula (V)). In formula (V), X2001, X2002,and X2023 are independently either present or absent. When present,X2001 is an amino acid selected from the group consisting of A, D, E, F,G, H, I, K, L, P, R, S, T, V and W; X2002 an amino acid selected fromthe group consisting of A, D, E, F, G, H, I, K, L, M, P, R, S, T, V andW; and X2023 is an amino acid selected from the group consisting of A,D, E, F, G, I, K, L, R, S, T, V, W and Y. In addition,

X2003 is an amino acid selected from the group consisting of A, F, I, K,L, R, S, T, V, W and Y;

X2004 is an amino acid selected from the group consisting of A, D, E, F,G, I, K, L, R, S, T, V and W;

X2005 is W;

X2006 is an amino acid selected from the group consisting of F, H, I, K,L, R, V and W;

X2007 is an amino acid selected from the group consisting of C, Hcy, Dapand K (e.g., C or Hcy);

X2008 is an amino acid selected from the group consisting of A, G, R, Sand T;

X2009 is an amino acid selected from the group consisting of a, A, I, K,L, M, m, Nle, p, R, Sem, and V;

X2010 is an amino acid selected from the group consisting of A, G, I, K,L, P, R, S, T and V;

X2011 is an amino acid selected from the group consisting of D, E, G, S,and T;

X2012 is an amino acid selected from the group consisting of A, a, D, d,E, e, F, f, G, I, K, k, L, l, M, m, Nle, nle, P, p, R, r, S, s, Sem, T,t, V, v, W and w;

X2013 is an amino acid selected from the group consisting of A, D, d, E,e, F, G, I, K, L, R, S, s, T, V and W;

X2014 is an amino acid selected from the group consisting of A, D, E, F,G, I, K, L, M, R, S, T, V and W;

X2015 is an amino acid selected from the group consisting of A, D, E, F,G, I, K, L, M, Nle, R, S, T, V and W;

X2016 is an amino acid selected from the group consisting of A, D, E, F,I, K, L, M, Nle, R, S, Sem, T, V, W and Y;

X2017 is an amino acid selected from the group consisting of A, D, E, F,G, I, K, L, R, S, T, V, W and Y;

X2018 is an amino acid selected from the group consisting of C and D(e.g., X2018 is C);

X2019 is an amino acid selected from the group consisting of A, F, I, L,S, T, V and W;

X2020 is an amino acid selected from the group consisting of F and W;

X2021 is an amino acid selected from the group consisting of I, L and V;and

X2022 is an amino acid selected from the group consisting of A, D, E, F,G, I, K, L, P, R, S, T, V, and W.

In some instances, in the peptide of the invention comprising thestructure of formula (V),

X2001 is optionally an amino acid selected from the group consisting ofA, D, F, G, H, K, L, P and S, such as an amino acid selected from thegroup consisting of A, D, F, G, H, K, L and S (when X2001 is present);

X2002 is optionally an amino acid selected from the group consisting ofA, D, F, G, H, K, L, P, R and S, such as an amino acid selected from thegroup consisting of A, F, H, K, L, M, R and S (e.g., H, F, M or R) (whenX2002 is present);

X2003 is optionally an amino acid selected from the group consisting ofA, F, K, L, S and Y, such as an amino acid selected from the groupconsisting of F, S and Y (e.g., F or Y);

X2004 is optionally an amino acid selected from the group consisting ofA, D, F, G, K, L and S (e.g., K);

X2005 is optionally W;

X2006 is optionally an amino acid selected from the group consisting ofF, H, K and L (e.g., F or H);

X2007 is optionally an amino acid selected from the group consisting ofC and HcY (e.g., X2007 is C);

X2008 is optionally an amino acid selected from the group consisting ofA, G and S;

X2009 is optionally an amino acid selected from the group consisting ofa, A, K, L, V, M, m, Nle, Sem, and p, such as an amino acid selectedfrom the group consisting of M, Nle, p and V (e.g., M, Sem, or V);

X2010 is optionally an amino acid selected from the group consisting ofA, G, K, L, P, R and S, such as an amino acid selected from the groupconsisting of A, K, L, P, R and S (e.g., K, P, or R);

X2011 is optionally an amino acid selected from the group consisting ofD, G and S (e.g., D or S);

X2012 is optionally an amino acid selected from the group consisting ofA, a, D, d, F, f, G, K, k, L, l, M, m, Nle, P, S and s, such as an aminoacid selected from the group consisting of D, d, F, f, G, K, k, L, l, M,Nle, P, S, and Sem (e.g., an amino acid selected from the groupconsisting of F, L, l, Sem, and M);

X2013 is optionally an amino acid selected from the group consisting ofA, D, d, F, G, K, L, S and s, such as an amino acid selected from thegroup consisting of A, D, F, G, K, L and S (e.g., D, G, K, or S);

X2014 is optionally an amino acid selected from the group consisting ofD, F, G, K, L and S (e.g., D or G);

X2015 is optionally an amino acid selected from the group consisting ofA, D, F, G, I, K, L, M, Nle, S and T (e.g., I or T);

X2016 is optionally an amino acid selected from the group consisting ofD, F, K, L, M, Nle, S, and Y, such as an amino acid selected from thegroup consisting of D, F, K, L, M, Nle, S, Sem, and Y (e.g., D, F, M,Sem, or Y);

X2017 is optionally an amino acid selected from the group consisting ofA, D, F, G, K, L, S, T and Y (e.g., S or T);

X2018 is optionally C;

X2019 is optionally an amino acid selected from the group consisting ofA, F, L, S and V (e.g., A or V);

X2020 is optionally an amino acid selected from the group consisting ofF and W (e.g., W);

X2021 is optionally an amino acid selected from the group consisting ofL and V (e.g., V);

X2022 is optionally an amino acid selected from the group consisting ofA, D, F, G, K, L, P, R, S and W, such as an amino acid selected from thegroup consisting of A, F, G, K, L, P, R, S and W (e.g., an amino acidselected from the group consisting of F, L, K, R, P and W); and

X2023 is optionally an amino acid selected from the group consisting ofA, D, F, G, K, L, M, S and Y, such as an amino acid selected from thegroup consisting of A, D, F, G, L M, S and Y (e.g., an amino acidsequence selected from the group consisting of A, D, F, M, S and Y)(when X2023 is present).

The invention further includes a peptide that binds TFPI, wherein thepeptide comprises the structure of formula (VI):X2001-X2002-F/Y-K-W-F/H-[C—X2008-M/V-X2010-D-X2012-X2013-G-1/T-X2016-S/T-C]-A/V-W-V-X2022-X2023(VI) (SEQ ID NO: 3119). In the peptide comprising the structure offormula (VI), X2001, X2002 and X2023 are each independently present orabsent. If X2001, X2002, and/or X2023 are present, any of X2001, X2002and X2023 is independently selected from any amino acid. In addition,X2008, X2010, X2012, X2013, X2016, and X2022 are each independentlyselected from any amino acid.

In some aspects, in the peptide of formula (VI),

X2001 is optionally an amino acid selected from the group consisting ofA, D, E, F, G, H, I, K, L, P, R, S, T, V and W, such as an amino acidselected from the group consisting of A, D, F, G, H, K, L, P and S(e.g., an amino acid selected from the group consisting of A, D, F, G,H, K, L and S) (when X2001 is present);

X2002 is optionally an amino acid selected from the group consisting ofA, D, E, F, G, H, I, K, L, M, P, R, S, T, V and W, such as an amino acidselected from the group consisting of A, D, F, G, H, K, L, M, P, R and S(e.g., an amino acid selected from the group consisting of A, F, H, K,L, M, R and 5, such as H, F, M, or R) (when X2002 is present);

X2008 is optionally an amino acid selected from the group consisting ofA, G, R, S and T, such as an amino acid selected from the groupconsisting of A, G and S;

X2010 is optionally an amino acid selected from the group consisting ofA, G, I, K, L, P, R, S, T and V, such as an amino acid selected from thegroup consisting of A, G, K, L, P, R and S (e.g., an amino acid selectedfrom the group consisting of A, K, L, P, R and S, such as K, P or R);

X2012 is optionally an amino acid selected from the group consisting ofA, a, D, d, E, e, F, f, G, I, I, K, k, L, l, M, m, Nle, nle, P, p, R, r,S, s, Sem, T, t, V, v, W and w, such as an amino acid selected from thegroup consisting of A, a, D, d, F, f, G, K, k, L, l, M, m, Nle, P, S, s,and Sem (e.g., an amino acid selected from the group consisting of D, d,F, f, G, K, k, L, l, M, Nle, P, S, and Sem, such as F, L, l, Sem, or M);

X2013 is optionally an amino acid selected from the group consisting ofA, D, d, E, e, F, G, I, K, L, R, S, s, T, V and W, such as an amino acidselected from the group consisting of A, D, d, F, G, K, L, S and s(e.g., an amino acid selected from the group consisting of A, D, F, G,K, L and S, such as D, G, K or S);

X2016 is optionally an amino acid selected from the group consisting ofA, D, E, F, I, K, L, M, Nle, R, S, Sem, T, V, W and Y, such as an aminoacid selected from the group consisting of D, F, K, L, M, Nle, S Sem,and Y (e.g., an amino acid selected from the group consisting of D, F,K, L, M, Nle, S, Sem, such as F, Sem, or M);

X2022 is optionally an amino acid selected from the group consisting ofA, D, E, F, G, I, K, L, P, R, S, T, V, and W, such as an amino acidselected from the group consisting of A, D, F, G, K, L, P, R, S and W(e.g., an amino acid selected from the group consisting of A, F, G, K,L, P, R, S and W, such as F, L, K, R, P or W); and/or

X2023 is optionally an amino acid selected from the group consisting ofA, D, E, F, G, I, K, L, R, M, S, T, V, W and Y, such as an amino acidselected from the group consisting of A, D, F, G, K, L, M, S and Y(e.g., an amino acid selected from the group consisting of A, D, F, G, LM, S and Y, such as A, D, F, M, S or Y) (when X2023 is present).

The TFPI-binding peptide of the invention, in one aspect, comprises anamino acid sequence having at least 60% identity (e.g., at least 60%, atleast 65%, at least 70%, at least 75%, at least 80%, at least 85%, atleast 90%, at least 95% or 100% identity) to the sequence of formulaVII: Ac-FYYKWH[CGMRDMKGTMSC]AWVKF-NH2 (VII) (SEQ ID NO: 1040).Optionally, the peptide comprises or consists of the amino acid sequenceof formula (V)-(VII) as defined herein. The invention also includes apeptide comprising or consisting of the amino acid sequence selectedfrom the group consisting of SEQ ID NOs: 1001-1293 (e.g., a peptidecomprising or consisting of the amino acid sequence selected from thegroup consisting of SEQ ID NOs: 1001-1212 and 1290-1291 (such as SEQ IDNOs: 1001-120, 1290, or 1291) and/or selected from the group consistingof SEQ ID NOs: 1213-1289 and/or selected from the group consisting of1292 and 1293).

The invention further provides a TFPI-binding peptide comprising thestructure of formula (VIII):X3001-X3002-X3003-X3004-X3005-X3006-X3007-X3008-X3009-X3010-X3011-X3012-X3013-X3014-X3015-X3016-X3017-X3018-X3019-X3020-X3021(VIII) (SEQ ID NO: 3120). In formula (VIII), X3001 and X3002 areindependently either present or absent in the peptide. If present, X3001is an amino acid selected from the group consisting of A, C, D, F, G, I,K, L, M, N, P, Q, R, S, T, W, E, H and Y; and X3002 is an amino acidselected from the group consisting of A, C, D, F, H, K, M, N, P, R, S,T, W, Y, G, I and L. In addition,

X3003 is an amino acid selected from the group consisting of A, C, D, E,F, G, H, I, K, L, M, N, P, Q, R, S, T, W and Y;

X3004 is an amino acid selected from the group consisting of A, C, D, E,F, G, H, I, K, L, M, N, Q, R, S, T, V, W, Y and P;

X3005 is an amino acid selected from the group consisting of C, D, F, G,H, I, K, L, M, N, P, R, S, T, V, W and Y;

X3006 is an amino acid selected from the group consisting of A, W, C, K,P, R and H;

X3007 is an amino acid selected from the group consisting of Q, A, C, F,G, H, I, K, L, N, R, S, T, W and Y;

X3008 is an amino acid selected from the group consisting of A, C, F, G,H, K, L, M, N, P, Q, R, S, T, V, W, Y and I;

X3009 is an amino acid selected from the group consisting of A, C, F, G,H, I, L, M, R, S, T, V, W, Y and K;

X3010 is an amino acid selected from the group consisting of A, C, F, G,H, I, K, L, M, N, P, Q, R, S, T, V, W and Y;

X3011 is an amino acid selected from the group consisting of A, G, I, K,L, M, N, Q, R, S, T, V, W, Y, C, F and H;

X3012 is an amino acid selected from the group consisting of A, C, H, I,K, L and R;

X3013 is an amino acid selected from the group consisting of A, C, F, G,H, K, L, M, R, S, V, W, Y and I;

X3014 is an amino acid selected from the group consisting of A, C, F, G,H, I, L, M, N, Q, R, S, T, V, W, Y and K;

X3015 is an amino acid selected from the group consisting of A, K and R;

X3016 is an amino acid selected from the group consisting of A, F, K andR;

X3017 is an amino acid selected from the group consisting of A, C, F, G,I, K, L, N, Q, R, S, T, V, W, Y, H, A and M;

X3018 is an amino acid selected from the group consisting of A, C, F, I,K, L, M, Q, R, V, W and Y;

X3019 is an amino acid selected from the group consisting of A, C, D, E,F, G, H, K, L, N, P, Q, R, V, W, Y and I;

X3020 is an amino acid selected from the group consisting of A, C, F, G,H, K, L, M, N, Q, R, V, W, Y, I and P; and

X3021 is an amino acid selected from the group consisting of A, C, H, I,K, L, M, N, P, Q, R, T, V, W, Y, F and G.

In some aspects of the invention, the peptide comprises the sequence offormula (VIII), wherein

X3001 is optionally an amino acid selected from the group consisting ofA, C, D, G, I, K, L, M, N, P, Q, R, S, T, W, E, H and Y, such as anamino acid selected from the group consisting of A, C, D, G, K, L, M, N,P, R, S, T, E, H and Y (when X3001 is present);

X3002 is optionally an amino selected from the group consisting of C, F,H, K, R, S, W, Y, G, I and L, such as an amino acid selected from thegroup consisting of C, K, R, W, Y, G, I and L (when X3002 is present);

X3003 is optionally an amino acid selected from the group consisting ofA, C, D, F, G, H, I, K, L, M, N, P, Q, R, S, T and W, such as an aminoacid selected from the group consisting of A, C, G, H, I, K, L, M, R, S,T and W;

X3004 is optionally an amino acid selected from the group consisting ofA, C, D, G, H, I, K, L, M, N, R, S, T, V and P, such as an amino acidselected from the group consisting of A, C, G, H, I, K, L, M, N, R, S, Tand P;

X3005 is optionally an amino acid selected from the group consisting ofC, F, H, I, K, M, R, T, W and Y, such as an amino acid selected from thegroup consisting of C, F, H, K, R and W;

X3006 is optionally an amino acid selected from the group consisting ofP, H and A;

X3007 is optionally an amino acid selected from the group consisting ofC, G, R, W, A and L, such as an amino acid selected from the groupconsisting of L, C, R and W;

X3008 is optionally an amino acid selected from the group consisting ofA, C, F, G, H, K, L, M, N, Q, R, T, V, W, Y and I, such as an amino acidselected from the group consisting of A, C, F, H, K, R, V, W, Y and I;

X3009 is optionally an amino acid selected from the group consisting ofC, I, R, V and K, such as an amino acid selected from the groupconsisting of C, R, V and K;

X3010 is optionally an amino acid selected from the group consisting ofA, C, G, H, I, K, L, M, Q, R, S and T, such as an amino acid selectedfrom the group consisting of A, C, K, L, Q, R and S;

X3011 is optionally an amino acid selected from the group consisting ofA, I, K, L, M, R, S, V, W, C, F and H, such as an amino acid selectedfrom the group consisting of I, K, L, M, R, V, W, C, F and H;

X3012 is optionally an amino acid selected from the group consisting ofH and R (e.g., H);

X3013 is optionally an amino acid selected from the group consisting ofC, F, K, L, M, R, V and I, such as an amino acid selected from the groupconsisting of C, K, R, V and I;

X3014 is optionally an amino acid selected from the group consisting ofA, M, C, F, H, I, L, N, R, S, V, W and K, such as an amino acid selectedfrom the group consisting of A, S, C, F, H, I, R and K;

X3015 is optionally K or R;

X3016 is optionally K or R;

X3017 is optionally an amino acid selected from the group consisting ofA, C, F, G, I, K, L, N, Q, R, S, T, V, W, H, A and M, such as an aminoacid selected from the group consisting of C, G, I, K, L, N, Q, R, S, T,V, H, A and M;

X3018 is optionally an amino acid selected from the group consisting ofA, K, C, I, L, R and W (e.g., K, C, I, R, or W);

X3019 is optionally an amino acid selected from the group consisting ofA, C, E, H, K, N, Q, R and I, such as an amino acid selected from thegroup consisting of C, E, H, K, R and I;

X3020 is optionally an amino acid selected from the group consisting ofC, H, L, M, R, V, I and P (e.g., C, M, I, or P); and

X3021 is optionally an amino acid selected from the group consisting ofA, C, H, I, K, L, M, N, Q, R, V, W, Y, F and G, such as an amino acidselected from the group consisting of A, C, H, I, K, L, M, N, Q, R, V,W, F and G.

The invention further provides a peptide that binds TFPI and comprisesthe structure of formula (IX):X3001-X3002-X3003-X3004-X3005-X3006-X3007-X3008-X3009-X3010-X3011-H-X3013-X3014-K/R-R-X3017-X3018-X3019-X3020-X3021(IX) (SEQ ID NO: 3121). In formula (IX), X3001 and X3002 areindependently either present or absent in the peptide. If present, X3001and/or X3002 are independently selected from any amino acid. Likewise,X3003, X3004, X3005, X3006, X3007, X3008, X3009, X3010, X3011, X3013,X3014, X3017, X3018, X3019, X3020 and X3021 are each independentlyselected from any amino acid. When present, X3001 is optionally an aminoacid selected from the group consisting of A, C, D, F, G, I, K, L, M, N,P, Q, R, S, T, W, E, H and Y, such as an amino acid selected from thegroup consisting of A, C, D, G, I, K, L, M, N, P, Q, R, S, T, W, E, Hand Y (e.g., an amino acid selected from the group consisting of A, C,D, G, K, L, M, N, P, R, S, T, E, H and Y). Likewise, when present, X3002is optionally an amino acid selected from the group consisting of A, C,D, F, H, K, M, N, P, R, S, T, W, Y, G, I and L, such as an amino acidselected from the group consisting of C, F, H, K, R, S, W, Y, G, I and L(e.g., an amino acid selected from the group consisting of C, K, R, W,Y, G, I and L). Also with respect to formula (IX),

X3003 is optionally an amino acid selected from the group consisting ofA, C, D, E, F, G, H, I, K, L, M, N, P, Q, R, S, T, W, and Y, such as anamino acid selected from the group consisting of A, C, D, F, G, H, I, K,L, M, N, P, Q, R, S, T and W (e.g., an amino acid selected from thegroup consisting of A, C, G, H, I, K, L, M, R, S, T and W);

X3004 is optionally an amino acid selected from the group consisting ofA, C, D, E, F, G, H, I, K, L, M, N, Q, R, S, T, V, W, Y and P, such asan amino acid selected from the group consisting of A, C, D, G, H, I, K,L, M, N, R, S, T, V and P (e.g., an amino acid selected from the groupconsisting of A, C, G, H, I, K, L, M, N, R, S, T and P);

X3005 is optionally an amino acid selected from the group consisting ofC, D, F, G, H, I, K, L, M, N, P, R, S, T, V, W and Y, such as an aminoacid selected from the group consisting of C, F, H, I, K, M, R, T, W andY (e.g., an amino acid selected from the group consisting of C, F, H, K,R and W);

X3006 is optionally an amino acid selected from the group consisting ofA, W, C, K, P, R and H, such as an amino acid selected from the groupconsisting of P, H and A;

X3007 is optionally an amino acid selected from the group consisting ofQ, A, C, F, G, H, I, K, L, N, R, S, T, W and Y, such as an amino acidselected from the group consisting of C, G, R, W, A and L (e.g., L, C, Ror W);

X3008 is optionally an amino acid selected from the group consisting ofA, C, F, G, H, K, L, M, N, P, Q, R, S, T, V, W, Y and I, such as anamino acid selected from the group consisting of A, C, F, G, H, K, L, M,N, Q, R, T, V, W, Y and I (e.g., an amino acid selected from the groupconsisting of A, C, F, H, K, R, V, W, Y and I);

X3009 is optionally an amino acid selected from the group consisting ofA, C, F, G, H, I, L, M, R, S, T, V, W, Y and K, such as an amino acidselected from the group consisting of C, I, R, V and K (e.g., C, R, V orK);

X3010 is optionally an amino acid selected from the group consisting ofA, C, F, G, H, I, K, L, M, N, P, Q, R, S, T, V, W and Y, such as anamino acid selected from the group consisting of A, C, G, H, I, K, L, M,Q, R, S and T (e.g., an amino acid selected from the group consisting ofA, C, K, L, Q, R and S);

X3011 is optionally an amino acid selected from the group consisting ofA, G, I, K, L, M, N, Q, R, S, T, V, W, Y, C, F and H, such as an aminoacid selected from the group consisting of A, I, K, L, M, R, S, V, W, C,F and H (e.g., an amino acid selected from the group consisting of I, K,L, M, R, V, W, C, F and H);

X3013 is optionally an amino acid selected from the group consisting ofA, C, F, G, H, K, L, M, R, S, V, W, Y and I, such as an amino acidselected from the group consisting of C, F, K, L, M, R, V, and I (e.g.,C, K, R, V, or I);

X3014 is optionally an amino acid selected from the group consisting ofA, C, F, G, H, I, L, M, N, Q, R, S, T, V, W, Y and K, such as an aminoacid selected from the group consisting of A, M, C, F, H, I, L, N, R, S,V, W and K (e.g., an amino acid selected from the group consisting of A,S, C, F, H, I, R and K);

X3017 is optionally an amino acid selected from the group consisting ofA, C, F, G, I, K, L, N, Q, R, S, T, V, W, Y, H, A and M, such as anamino acid selected from the group consisting of A, C, F, G, I, K, L, N,Q, R, S, T, V, W, H, A and M (e.g., an amino acid selected from thegroup consisting of C, G, I, K, L, N, Q, R, S, T, V, H, A and M);

X3018 is optionally an amino acid selected from the group consisting ofA, C, F, I, K, L, M, Q, R, V, W and Y, such as an amino acid selectedfrom the group consisting of A, K, C, I, L, R and W (e.g., K, C, I, R,or W);

X3019 is optionally an amino acid selected from the group consisting ofA, C, D, E, F, G, H, K, L, N, P, Q, R, V, W, Y and I, such as an aminoacid selected from the group consisting of A, C, E, H, K, N, Q, R and I(e.g., C, E, H, K, R, or I);

X3020 is optionally an amino acid selected from the group consisting ofA, C, F, G, H, K, L, M, N, Q, R, V, W, Y, 1 and P, such as an amino acidselected from the group consisting of C, H, L, M, R, V, 1 and P (e.g.,C, M, I, or P); and/or

X3021 is optionally an amino acid selected from the group consisting ofA, C, H, I, K, L, M, N, P, Q, R, T, V, W, Y, F and G, such as an aminoacid selected from the group consisting of A, C, H, I, K, L, M, N, Q, R,V, W, Y, F and G (e.g., an amino acid selected from the group consistingof A, C, H, I, K, L, M, N, Q, R, V, W, F and G).

The TFPI-binding peptide of the invention comprises, in some aspects, anamino acid sequence having at least 60% identity (e.g., at least 65%, atleast 70%, at least 75%, at least 80%, at least 85%, at least 90%, atleast 95% or 100% identity) to the sequence of formula (X):Ac-GYASFPWFVQLHVHKRSWEMA-NH2 (X) (SEQ ID NO: 223). Optionally, thepeptide comprises or consists of the amino acid sequence of formula(VIII)-(IX) as defined herein. As used herein, “at least 60% identity”and similar terms encompass any integer from, e.g., 60%, to 100%, suchas 60%, 61%, 62%, and the like. Also, the term “at least [percentage]identity” encompasses any percentage that is greater than or equal tothe number of identical amino acids divided by the total number of aminoacids of the peptide of the invention ([at least percentageidentity]≧[number of identical amino acids]/[total number of amino acidsof the peptide of the invention]).

The invention also includes a peptide comprising or consisting of theamino acid sequence selected from the group consisting of SEQ ID NOs:2001-2498 (e.g., a peptide comprising or consisting of the amino acidsequence selected from the group consisting of SEQ ID NOs: 2001-2296 and2498 (such as SEQ ID NOs: 2001-2126, 2128-2296, or 2498) and/or selectedfrom the group consisting of SEQ ID NOs: 2297-2497 (such as SEQ ID NOs:2298-2497)). The invention further provides a peptide comprising orconsisting of the amino acid sequence selected from the group consistingof SEQ ID NOs: 3001-3108 (e.g., a peptide comprising or consisting ofthe amino acid sequence selected from the group consisting of SEQ IDNOs: 3001-3064 (such as SEQ ID NOs: 3001-3048, 3051-3053, 3055, or3057-3064) and/or selected from the group consisting of SEQ ID NOs:3065-3084 (such as SEQ ID NOs: 3066-3084) and/or selected from the groupconsisting of SEQ ID NOs: 3085-3108).

The peptide of SEQ ID NOs: 1-7 also, in some aspects, comprises one ormore amino acids attached at the N- or C-terminus of SEQ ID NOs: 1-7.For example, the invention includes a peptide comprising or consistingof the amino acid sequence of JBT0047, JBT0051, JBT0055, JBT0131,JBT0132, JBT0133, JBT0155, JBT0158, JBT0162, JBT0163, JBT0164, JBT0166,JBT0169, JBT0170, JBT0171, JBT0174, JBT0175, or JBT0293, all of whichcomprise the amino acid sequence of SEQ ID NO: 1. Exemplary peptidescomprising the amino acid sequence of SEQ ID NO: 2 include peptidescomprising or consisting of the amino acid sequence of JBT0294, JBT0295,JBT0296, JBT0297, JBT0298, JBT0299, JBT0300, JBT0301, JBT0302, JBT0303,JBT0304, JBT0305, JBT0306, JBT0307, JBT0308, JBT0309, JBT0310, orJBT0311. Exemplary peptides comprising the amino acid sequence of SEQ IDNO: 3 comprise or consist of the amino acid sequence of JBT0049,JBT0053, JBT0057, JBT0190, JBT0193, or JBT0197. The invention furtherincludes a peptide comprising or consisting of the amino acid sequenceof JBT0050, JBT0054, JBT0058, JBT0129, JBT0130, JBT0205, JBT0208,JBT0211, JBT0212, JBT0217, JBT0218, or JBT0219, all of which include theamino acid sequence of SEQ ID NO: 4. Exemplary peptides comprising SEQID NO: 5 include those comprising or consisting of the amino acidsequence of JBT0101, JBT0052, JBT0103, JBT0178, or JBT0182. Theinvention additionally includes a peptide comprising or consisting ofthe amino acid sequence of JBT0120, JBT0124, JBT0247, JBT0248, JBT0251,or JBT0252, each of which include the amino acid sequence of SEQ ID NO:6. A peptide including the amino acid sequence of SEQ ID NO: 7, e.g., apeptide comprising or consisting of the amino acid sequence of JBT0122,JBT0126. JBT0221, JBT0224, JBT0225, JBT0226, JBT0228, JBT0232, orJBT0233, also provided by the invention. The peptides described hereinare set forth in Table 5 of Example 1 and in FIGS. 12-18.

In certain embodiments, the peptide of the invention comprises orconsists of the amino acid sequence of JBT0047, JBT0049, JBT0101,JBT0120, or JBT0122 or any of the inventive peptides described herein(e.g., a peptide comprising or consisting of the amino acid sequence ofany one of SEQ ID NOs: 1-3108, such as a peptide comprising orconsisting of the amino acid sequence of any one of SEQ ID NOs: 8-741,744-968, 971-978, 1001-1210, 1213-1289, 1290-1293, 2001-2126, 2128-2296,2298-2498, 3001-3048, 3051-3053, 3055, 3057-3064, and 3067-3108), or avariant of any of the foregoing. By “variant” is meant a peptidecomprising one or more amino acid substitutions, amino acid deletions,or amino acid additions to a parent amino acid sequence. Variantsinclude, but are not limited to, peptides having an amino acid sequencethat is at least 60%, 65%, 70%, 71%, 72%, 73%, 74%, 75%, 76%, 77%, 78%,79%, 80%, 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%,93%, 94%, 95%, 96%, 97%, 98% or 99% identical to any of the amino acidsequences provided herein while retaining the ability to bind TFPIand/or inhibit TFPI activity. In one embodiment, the peptide comprisesor consists of the amino acid sequence of JBT0132, JBT0303, JBT0193,JBT0178, JBT0120, or JBT0224.

In one aspect, the peptide of the invention consists of 40 amino acidsor less, such as 35 amino acids or less. Optionally, the peptide of theinvention consists of 25 amino acids or less, or 10 amino acids or less.In various embodiments, the peptide comprises 15-35 amino acid residues(e.g., 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30,31, 32, 33, 34, or 35 amino acid residues). However, it is alsocontemplated that a peptide described herein comprising one or moredeletions is suitable in the context of the invention so long as thepeptide blocks TFPI inhibition of the coagulation cascade and,optionally, binds TFPI. In one aspect, the peptide comprising one ormore deletions is suitable in the context of the invention so long asthe peptide binds TFPI and, optionally, blocks TFPI inhibition of thecoagulation cascade. In some aspects, amino acids are removed fromwithin the amino acid sequence, at the N-terminus, and/or at theC-terminus. Such peptide fragments can comprise 3-14 amino acid residues(e.g., 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, or 14 amino acid residues).

Optionally, the peptide of the invention comprises one or more aminoacid substitutions (with reference to any of the amino acid sequencesprovided herein) that do not destroy the ability of the peptide to bindand/or inhibit TFPI. For instance, peptides comprising or consisting ofthe amino acid sequence selected from the group consisting of JBT0294,JBT0295, JBT0296, JBT0297, JBT0298, JBT0299, JBT0300, JBT0301, JBT0302,JBT0303, JBT0304, JBT0305, JBT0306, JBT0307, JBT0308, JBT0309, JBT0310,or JBT0311 are substitutional mutants of the amino acid sequence ofJBT0293 (the amino acid sequence of SEQ ID NO: 1 directly linked to aphenylalanine residue at the N-terminus and a lysine reside at theC-terminus) (see FIG. 4). Amino acid substitutions include, but are notlimited to, those which: (1) reduce susceptibility to proteolysis, (2)reduce susceptibility to oxidation, (3) alter binding affinities, and/or(4) confer or modify other physiochemical or functional properties on apeptide. In one aspect, the substitution is a conservative substitution,wherein an amino acid residue is replaced with an amino acid residuehaving a similar side chain. Families of amino acid residues havingsimilar side chains have been defined within the art, and include aminoacids with basic side chains (e.g., lysine, arginine, and histidine),acidic side chains (e.g., aspartic acid and glutamic acid), unchargedpolar side chains (e.g., glycine, asparagine, glutamine, serine,threonine, tyrosine, and cysteine), nonpolar side chains (e.g., alanine,valine, leucine, isoleucine, proline, phenylalanine, methionine, andtryptophan), beta-branched side chains (e.g., threonine, valine, andisoleucine) and aromatic side chains (e.g., tyrosine, phenylalanine,tryptophan, and histidine). It will be appreciated, however, that apractitioner is not limited to creating conservative substitutions solong as the resulting peptide retains the ability to downregulate, inwhole or in part, TFPI activity. The invention also embracesTFPI-inhibitory peptides comprising atypical, non-naturally occurringamino acids, which are well known in the art. Exemplary non-naturallyoccurring amino acids include ornithine, citrulline, hydroxyproline,homoserine, phenylglycine, taurine, iodotyrosine, 2,4-diaminobutyricacid, α-amino isobutyric acid, 4-aminobutyric acid, 2-amino butyricacid, y-amino butyric acid, 2-amino isobutyric acid, 3-amino propionicacid, norleucine, norvaline, sarcosine, homocitrulline, cysteic acid,t-butylglycine, t-butylalanine, phenylglycine, cyclohexylalanine,β-alanine, a fluoro-amino acid, a 3-methyl amino acid, α-C-methyl aminoacid, a N-methyl amino acid, 2-amino-isobutyric acid, β-homoglutamaticacid, β-homophenylalanine, β-homolysine, β-homoleucine,β-homoasparagine, β-homoglutamine, β-homoarginine, β-homoserine,β-homotyrosine, β-homoaspartic acid, β-homovaline, β-homoasparagin,(S)-cyclohexylalanine, (S)-citrullin, (S)-2,4-diaminobutyric acid,(S)-2,4-diaminobutyric acid, (S)-diaminopropionic acid,(S)-2-propargylglycine, (S)—N(omega)-nitro-arginine,L-homophenylalanine, S)-homo-arginine, (S)-homo-citrulline,(S)-homo-cysteine, (S)-2-amino-5-methyl-hexanoic acid, (S)-homo-lysine,(S)-norleucine, (S)—N-methylalanine, (S)—N-methyl-aspartic acid,(S)—N-methyl-glutamic acid, (S)—N-methyl-phenylalanine,N-methyl-glycine, (S)—N-methyl-lysine, (S)—N-methyl-leucine,(S)—N-methyl-arginine, (S)—N-methyl-serine, (S)—N-methyl-valine,(S)—N-methyl-tyrosine, (S)-2-amino-pentanoic acid,(S)-2-pyridyl-alanine, (S)-ornithine, L-phenylglycin, 4-phenyl-butyricacid and selenomethionine. The individual amino acids may have either Lor D stereochemistry when appropriate, although the L stereochemistry istypically employed for all of the amino acids in the peptide.

The invention further includes TFPI-inhibitory peptide variantscomprising one or more amino acids inserted within an amino acidsequence provided herein and/or attached to the N-terminus orC-terminus. In one aspect, the peptide further comprises one or moreamino acids that facilitate synthesis, handling, or use of the peptide,including, but not limited to, one or two lysines at the N-terminusand/or C-terminus to increase solubility of the peptide. Suitable fusionproteins include, but are not limited to, proteins comprising aTFPI-inhibitory peptide linked to one or more polypeptides, polypeptidefragments, or amino acids not generally recognized to be part of theprotein sequence. In one aspect, a fusion peptide comprises the entireamino acid sequences of two or more peptides or, alternatively,comprises portions (fragments) of two or more peptides. In addition toall or part of the TFPI-inhibitory peptides described herein, a fusionprotein optionally includes all or part of any suitable peptidecomprising a desired biological activity/function. Indeed, in someaspects, a TFPI-inhibitory peptide is operably linked to, for instance,one or more of the following: a peptide with long circulating half life,a marker protein, a peptide that facilitates purification of theTFPI-inhibitory peptide, a peptide sequence that promotes formation ofmultimeric proteins, or a fragment of any of the foregoing. In oneembodiment, two or more TFPI-inhibitory peptides are fused together,linked by a multimerization domain, or attached via chemical linkage togenerate a TFPI-inhibitory peptide complex. The TFPI-inhibitor peptidesmay be the same or different.

“Derivatives” are included in the invention and include TFPI-inhibitorypeptides that have been chemically modified in some manner distinct fromaddition, deletion, or substitution of amino acids. In this regard, apeptide of the invention provided herein is chemically bonded withpolymers, lipids, other organic moieties, and/or inorganic moieties.Examples of peptide and protein modifications are given in Hermanson,Bioconjugate Techniques, Academic Press, (1996). Derivatives areprepared in some situations to increase solubility, stability,absorption, or circulating half-life. Various chemical modificationseliminate or attenuate any undesirable side effect of the agent. In thisregard, the invention includes TFPI-inhibitory peptides covalentlymodified to include one or more water soluble polymer attachments.Useful polymers known in the art include, but are not limited to,polyethylene glycol (PEG) (e.g., PEG approximately 40 kD or 1 kD insize), polyoxyethylene glycol, polypropylene glycol,monomethoxy-polyethylene glycol, dextran, cellulose, poly-(N-vinylpyrrolidone)-polyethylene glycol, propylene glycol homopolymers, apolypropylene oxide/ethylene oxide co-polymer, polyoxyethylated polyols(e.g., glycerol) and polyvinyl alcohol, as well as mixtures of any ofthe foregoing. In one aspect, the peptide of the invention is aPEGylated peptide. For further discussion of water soluble polymerattachments, see U.S. Pat. Nos. 4,640,835; 4,496,689; 4,301,144;4,670,417; 4,791,192; and 4,179,337. In another aspect, a peptidederivative includes a targeting moiety specific for a particular celltype, tissue, and/or organ. Alternatively, the peptide is linked to oneor more chemical moieties that facilitate purification, detection,multimerization, and characterization of peptide activity. An exemplarychemical moiety is biotin. In addition, in one aspect, the peptides ofthe invention are acylated at the N-terminal amino acid of the peptide.In another aspect, the peptides of the invention are amidated at theC-terminal amino acid of the peptide. In a still further aspect, thepeptides of the invention are acylated at the N-terminal amino acid ofthe peptide and are amidated at the C-terminal amino acid of thepeptide.

Derivatives also include peptides comprising modified ornon-proteinogenic amino acids or a modified linker group (see, e.g.,Grant, Synthetic Peptides: A User's Guide, Oxford University Press(1992)). Modified amino acids include, for example, amino acids whereinthe amino and/or carboxyl group is replaced by another group.Non-limiting examples include modified amino acids incorporatingthioamides, ureas, thioureas, acylhydrazides, esters, olefines,sulfonamides, phosphoric acid amides, ketones, alcohols, boronic acidamides, benzodiazepines and other aromatic or non-aromatic heterocycles(see Estiarte et al., Burgers Medicinal Chemistry, 6th edition, Volume1, Part 4, John Wiley & Sons, New York (2002)). Modified amino acids areoften connected to the peptide with at least one of the above mentionedfunctional groups instead of an amide bond. Non-proteinogenic aminoacids include, but are not limited, to β-alanine (Bal), norvaline (Nva),norleucine (Nle), 4-aminobutyric acid (γ-Abu), 2-aminoisobutyric acid(Aib), 6-aminohexanoic acid (ε-Ahx), ornithine (Orn), hydroxyproline(Hyp), taurine, sarcosine, citrulline (Cit), cysteic acid (Coh),cyclohexylalanine (Cha), methioninesulfoxide (Meo), methioninesulfone(Moo), homoserinemethylester (Hsm), propargylglycine (Eag),5-fluorotryptophan (5Fw), 6-fluorotryptophan (6Fw),3′,4′-dimethoxyphenyl-alanine (Ear), 3′,4′-difluorophenylalanine (Dff),4′-fluorophenyl-alanine (Pff), 1-naphthyl-alanine (1Ni),1-methyltryptophan (1Mw), penicillamine (Pen), homoserine (Hse),t-butylglycine, t-butylalanine, phenylglycine (Phg), benzothienylalanine(Bta), L-homo-cysteine (Hcy), N-methyl-phenylalanine (Nmf),2-thienylalanine (Thi), 3,3-diphenylalanine (Ebw), homophenylalanine(Hfe) and S-benzyl-L-cysteine (Ece). These and other non-proteinogenicamino acids may exist as D- or L-isomers. Examples of modified linkersinclude, but are not limited to, the flexible linker4,7,10-trioxa-1,13-tridecanediamine (Ttds), glycine, 6-aminohexanoicacid, beta-alanine (Bal), and combinations of Ttds, glycine,6-aminohexanoic acid and Bal.

Homologues of the amino acids constituting the peptides of the inventionmay be as set forth in Table 3.

TABLE 3 Amino Acid Exemplary homologues A Aib, Bal, Eag, Nma, Abu, G, M,Nva, Nle C S, A, Hcy, M, L, I, V, Nmc, β-Cysteine D E, Homoglutamicacid, γ-Hydroxy-glutamic acid, γ-Carboxy- glutamic acid, Nmd, β-Asparticacid, N, Q, Cysteic acid E D, Glu, Homoglutamic acid, γ-Hydroxy-glutamicacid, γ- Carboxy-glutamic acid, α-Aminoadipic acid, Nme, β-glutamicacid, Q, N, Cysteic acid F Hfe, Nmf, β-Phenylalanine, Phg, Bhf,Thienylalanine, Benzothienylalanine, Bromophenylalanine,Iodophenylalanione, Chlorophenylalanine, Methylphenylalanine,Nitrophenylalanine, Y, W, Naphtylalanine, Tic G A, Nmg H Nmh,1-Methylhistidine, 3-Methylhistidine, Thienylalanine I L, V, Hle, Nva,Nle, β-Isoleucine, Nml, M, Nmi K Nmk, R, Nmr, β-Lysine, Dab, Dap,β-(1-Piperazinyl)-alanine, 2,6-Diamino-4-hexynoic acid,delta-Hydroxy-lysine, Har, omega-Hydroxy-norarginine,omega-Amino-arginine, omega- Methyl-arginine, β-(2-Pyridyl)-alanine,β-(3-Pyridyl)-alanine, 3-Amino-tyrosine, 4-Amino-phenylalanine, Hci, CitL I, V, Hle, Nle, Nva, β-Isoleucine, Nml, M M I, V, Hle, Nva, R, Har,Nmm, Methioninesulfone N Nmn, β-Asparagine, Q, Nmq, β-Glutamine,Cys(3-propionic acid amide)-OH, Cys(O2-3-propionic acid amide)-OH PAzetidine-2-carboxylic acid, Hyp, α-Methyl-methionine, 4-Hydroxy-piperidine-2-carboxylic acid, Pip, α-Methyl-Pro Q N, Nmn, Nmq,β-Glutamine, Cys(3-propionic acid amide)-OH, Cys(O2-3-propionic acidamide)-OH R Nmk, K, Nmr, β-Lysine, Dab, Dap, Orn, β-(1-Piperazinyl)-alanine, 2,6-Diamino-4-hexynoic acid, delta-Hydroxy-lysine, Har,omega-Hydroxy-norarginine, omega-Amino-arginine, omega-Methyl-arginine,β-(2-Pyridyl)-alanine, β- (3-Pyridyl)-alanine, 3-Amino-tyrosine,4-Amino-phenylalanine, Hci, Cit, Hle, L, Nle, M S T, Hse, β-Serine, C,β-Cyano-alanine, allo-Threonine T S, Homothreonine, β-Threonine,allo-Threonine V L, I, Hle, Nva, Nle, β-Valine, Nmv, M, Nmi, Nml W Nmw,β-Tryptophan, F, Hfe, Nmf, β-Phenylalanine, Phg, Bhf, Thienylalanine,Benzothienylalanine, Bromophenylalanine, Iodophenylalanine,Chlorophenylalanine, Methylphenylalanine, Nitrophenylalanine, Y,Naphtylalanine, Tic Y Nmy, β-Tyrosine,, F, Hfe, Nmf, β-Phenylalanine,Phg, Bhf, Thienylalanine, Benzothienylalanine, Bromophenylalanine,Iodophenylalanine, Chlorophenylalanine, Methylphenylalanine,Nitrophenylalanine, W, Naphtylalanine, Tic

In some embodiments, the peptide (CO—NH) linkages joining amino acidswithin the peptide of the invention are reversed to create a“retro-modified” peptide, i.e., a peptide comprising amino acid residuesassembled in the opposite direction (NH—CO bonds) compared to thereference peptide. The retro-modified peptide comprises the same aminoacid chirality as the reference peptide. An “inverso-modified” peptideis a peptide of the invention comprising amino acid residues assembledin the same direction as a reference peptide, but the chirality of theamino acids is inverted. Thus, where the reference peptide comprisesL-amino acids, the “inverso-modified” peptide comprises D-amino acids,and vice versa. Inverso-modified peptides comprise CO—NH peptide bonds.A “retro-inverso modified” peptide refers to a peptide comprising aminoacid residues assembled in the opposite direction and which haveinverted chirality. A retro-inverso analogue has reversed termini andreversed direction of peptide bonds (i.e., NH—CO), while approximatelymaintaining the side chain topology found in the reference peptide.Retro-inverso peptidomimetics are made using standard methods, includingthe methods described in Meziere et al, J. Immunol., 159, 3230-3237(1997), incorporated herein by reference. Partial retro-inverso peptidesare peptides in which only part of the amino acid sequence is reversedand replaced with enantiomeric amino acid residues.

TFPI-binding peptides of the invention (e.g., TFPI inhibitor peptides)are made in a variety of ways. In one aspect, the peptides aresynthesized by solid phase synthesis techniques including thosedescribed in Merrifield, J. Am. Chem. Soc., 85, 2149 (1963); Davis etal., Biochem. Intl., 10, 394-414 (1985); Larsen et al., J. Am. Chem.Soc., 115, 6247 (1993); Smith et al., J. Peptide Protein Res., 44, 183(1994); O'Donnell et al., J. Am. Chem. Soc., 118, 6070 (1996); Stewartand Young, Solid Phase Peptide Synthesis, Freeman (1969); Finn et al.,The Proteins, 3rd ed., vol. 2, pp. 105-253 (1976); and Erickson et al.,The Proteins, 3rd ed., vol. 2, pp. 257-527 (1976). Alternatively, theTFPI-binding peptide (e.g., the TFPI-inhibitory peptide) is expressedrecombinantly by introducing a nucleic acid encoding a TFPI-bindingpeptide (e.g., a TFPI-inhibitory peptide) into host cells, which arecultured to express the peptide. Such peptides are purified from thecell culture using standard protein purification techniques.

The invention also encompasses a nucleic acid comprising a nucleic acidsequence encoding a TFPI-inhibitory peptide of the invention. Methods ofpreparing DNA and/or RNA molecules are well known in the art. In oneaspect, a DNA/RNA molecule encoding a peptide provided herein isgenerated using chemical synthesis techniques and/or using polymerasechain reaction (PCR). If desired, a TFPI-inhibitory peptide codingsequence is incorporated into an expression vector. One of ordinaryskill in the art will appreciate that any of a number of expressionvectors known in the art are suitable in the context of the invention,such as, but not limited to, plasmids, plasmid-liposome complexes, andviral vectors. Any of these expression vectors are prepared usingstandard recombinant DNA techniques described in, e.g., Sambrook et al.,Molecular Cloning, a Laboratory Manual, 2d edition, Cold Spring HarborPress, Cold Spring Harbor, N.Y. (1989), and Ausubel et al., CurrentProtocols in Molecular Biology, Greene Publishing Associates and JohnWiley & Sons, New York, N.Y. (1994). Optionally, the nucleic acid isoperably linked to one or more regulatory sequences, such as a promoter,activator, enhancer, cap signal, polyadenylation signal, or other signalinvolved with the control of transcription or translation.

Any of the TFPI-inhibitory peptides of the invention or nucleic acidsencoding the peptides also is provided in a composition (e.g., apharmaceutical composition). In this regard, the peptide is formulatedwith a physiologically-acceptable (i.e., pharmacologically-acceptable)carrier, buffer, excipient, or diluent, as described further herein.Optionally, the peptide is in the form of a physiologically acceptablesalt, which is encompassed by the invention. “Physiologically acceptablesalts” means any salts that are pharmaceutically acceptable. Someexamples of appropriate salts include acetate, hydrochloride,hydrobromide, sulfate, citrate, tartrate, glycolate, and oxalate. Ifdesired, the composition comprises one or more additionalpharmaceutically-effective agents.

The peptide provided herein optionally inhibits at least one TissueFactor Pathway Inhibitor-1 (e.g., TFPI-1α) activity such as, but notlimited to, an activity that down-regulates the blood coagulationcascade. Without being bound by any specific mechanism of action, aproposed mechanism of inhibition may involve preventing formation of thequaternary TF-FVIIA-FXA-TFPI complex. The peptide may inhibit binding ofTFPI to FXa (e.g., inhibit binding of TFPI Kunitz domain 2 to FactorXa), the TF/FVIIa complex (e.g., inhibit binding of TFPI Kunitz domain 1to the TF/FVIIa complex), TF alone, and/or FVIIa alone. With TFPIactivity diminished, TF and FVIIa are free to activate FX which, inturn, enhances conversion of prothrombin to thrombin.

In one aspect, the peptide of the invention exhibits TFPI antagonisticactivity in model and/or plasmatic systems. An exemplary model systemfor determining TFPI-inhibitory activity is the extrinsic tenase assay,which tests the ability of candidate peptides to restore extrinsiccomplex-mediated FX activation in the presence of TFPI (which is anatural inhibitor of the FX activation reaction) (see, e.g., Lindhout etal., Thromb. Haemost., 74, 910-915 (1995)). Another model system forcharacterizing TFPI-inhibitory activity is the FXa inhibition assay,wherein FXa activity is measured in the presence of TFPI (see Sprecheret al., PNAS, 91, 3353-3357 (1994)). The extrinsic tenase assay and theFXa inhibition assay are further described in Example 3. Optionally, thepeptide of the invention enhances FX activation in the presence of TFPIwith a half maximal effective concentration (EC₅₀) of less than or equalto 1×10⁻⁴M, less than or equal to 1×10⁻⁵M, less than or equal to1×10⁻⁶M, or less than or equal to 1×10⁻⁷ M.

In one aspect, TFPI-antagonist activity is characterized in aplasma-based assay. Thrombin formation is triggered in plasmasubstantially lacking FVIII or FIX activity (e.g., the residualcoagulation factor activity is lower than 1%) in the presence of acandidate peptide. Thrombin formation can be detected using afluorogenic or chromogenic substrate, as described in Example 4. Asystem for measuring thrombin activity is provided by Thrombinoscope BV(Maastricht, The Netherlands). Prothrombin conversion is measured using,e.g., a Thrombograph™ (Thermo Scientific, Waltham, Mass.), and theresulting data is compiled into a Calibrated Automatic Thrombogramgenerated by Thrombinoscope™ software available from Thrombinoscope BV.In certain embodiments, the TFPI-inhibitory peptide increases the amountof peak thrombin generated during the assay and/or decreases the timerequired to achieve peak thrombin formation. For example, the peptideimproves TFPI-regulated thrombin generation in the absence of FVIII(e.g., in FVIII-depleted plasma) to at least 1% of the level ofTFPI-dependent thrombin generation in normal plasma. Generally, normal(unafflicted) plasma contains about 0.5 U/mL to about 2 U/mL FactorVIII. Accordingly, in some instances, a TFPI-inhibitor peptide willenhance thrombin formation in the absence of FVIII to at least about 1%of that observed in the presence of 0.5 U/mL to 2 U/mL FVIII. In furtherembodiments, the peptide enhances thrombin formation in the absence ofFactor VIII to at least about 2%, at least about 3%, at least about 5%,at least about 7%, or at least about 10% of the level of thrombinformation in normal plasma, i.e., in the presence of physiologicallevels of Factor VIII. In various aspects, the peptide is administeredto an animal model of thrombin deficiency or hemophilia to characterizeTFPI inhibitory activity in vivo. Such in vivo models are known in theart and include for example, mice administered anti-FVIII antibodies toinduce hemophilia A (Tranholm et al., Blood, 102, 3615-3620 (2003));coagulation factor knock-out models such as, but not limited to, FVIIIknock-out mice (Bi et al., Nat. Genet., 10(1), 119-121 (1995)) and FIXknock-out mice (Wang et al., PNAS, 94(21), 11563-66 (1997)); inducedhemophilia-A in rabbits (Shen et al., Blood, 42(4), 509-521 (1973)); andChapel Hill HA dogs (Lozier et al., PNAS, 99, 12991-12996 (2002)).

While not being bound to any particular theory or mechanism, the peptideof the invention provided herein may inhibit TFPI activity by blocking(competitively or allosterically) binding of TFPI and FXa. Alternativelyor in addition, the peptide may inhibit binding of TFPI with a TissueFactor (TF)/Factor VIIa complex. Thus, in certain aspects, the peptidespecifically binds TFPI. Various peptides bind TFPI from any sourceincluding, but not limited to, mouse, rat, rabbit, dog, cat, cow, horse,pig, guinea pig, and primate. In one embodiment, the peptide binds humanTFPI. Optionally, the TFPI-inhibitory peptide binds TFPI from more thanone species (i.e., the peptide is cross-reactive among multiplespecies). In certain aspects, the peptide binds TFPI with a dissociationconstant (K_(D)) of less than or equal to 1×10⁻⁴M, less than or equal to1×10⁻⁵M, less than or equal to 1×10⁻⁶M, or less than or equal to1×10⁻⁷M. Affinity may be determined using, for example and withoutlimitation, any one, two, or more of a variety of techniques, such asaffinity ELISA assay, a competitive ELISA assay, and/or surface plasmonresonance (BIAcore™) assay. When characterized using a competitive(IC₅₀) ELISA assay, the peptide of the invention optionally demonstratesan IC₅₀ of less than or equal to about 50,000 nM. For example, thepeptide demonstrates an IC₅₀ of less than or equal to about 10,000 nM,such as an IC₅₀ of less than or equal to about 5,000 nM, less than orequal to about 1,000 nM, or less than or equal to about 500 nM. In oneaspect, the peptide demonstrates an IC₅₀ of less than or equal to about250 nM, less than or equal to about 100 nM, or less than or equal toabout 50 nM. Exemplary peptides and their IC₅₀ values are provided inFIGS. 32-39; in some instances, the peptides are classified into GroupsA, B, C, D, E, F, and G (see Table 4 in Example 1) based on their IC₅₀values. In various aspects, the invention provides peptides fallingwithin Groups A, B, C, D, E, F, and/or G as defined in Table 4. Affinitymay also be determined by a kinetic method or an equilibrium/solutionmethod. Such methods are described in further detail herein or known inthe art.

As with all binding agents and binding assays, one of skill in the artrecognizes that the various moieties to which a binding agent should notdetectably bind in order to be biologically (e.g., therapeutically)effective would be exhaustive and impractical to list. Therefore, theterm “specifically binds” refers to the ability of a peptide to bindTFPI with greater affinity than it binds to an unrelated control proteinthat is not TFPI. For example, the peptide may bind to TFPI with anaffinity that is at least, 5, 10, 15, 25, 50, 100, 250, 500, 1000, or10,000 times greater than the affinity for a control protein. In someembodiments, the peptide binds TFPI with greater affinity than it bindsto an “anti-target,” a protein or other naturally occurring substance inhumans to which binding of the peptide might lead to adverse effects.Several classes of peptides or proteins are potential anti-targets.Because TFPI-inhibitory peptides exert their activity in the bloodstream and/or at the endothelium, plasma proteins represent potentialanti-targets. Proteins containing Kunitz domains (KDs) are potentialanti-targets because KDs of different proteins share a significantsimilarity. Tissue Factor Pathway Inhibitor-2 (TFPI-2) is highly similarto TFPI-1α and, like TFPI-1α, contains KDs (Sprecher et al., PNAS, 91,3353-3357 (1994)). Thus, in one aspect, the peptide of the inventionbinds to TFPI with an affinity that is at least 5, 10, 15, 25, or 50times greater than the affinity for an anti-target, such as TFPI-2.

The invention further includes a method of inhibiting Tissue FactorPathway Inhibitor-1 (TFPI). The method comprises contacting TFPI with aTFPI-binding peptide as described herein. Any degree of TFPI-activityinhibition is contemplated. For example, a TFPI-inhibitory peptidereduces TFPI-inhibition of the extrinsic pathway at least about 5%(e.g., at least about 10%, at least about 25%, or at least about 30%).In some embodiments, the TFPI-inhibitory peptide reduces TFPI activitywithin the extrinsic pathway at least about 50%, at least about 75%, orat least about 90% compared to TFPI activity in the absence of thepeptide.

The invention further includes a method for targeting biologicalstructures (including, but not limited to, cell surfaces and endotheliallining) where TFPI is located. The method comprises contacting thebiological structure (e.g., including, without limitation, a celldisplaying TFPI on the cell surface) with a TFPI-binding peptidedescribed herein, optionally conjugated to a moiety that adds additionalfunctionality to the peptide. The moiety can be a dye (such as afluorescence dye), a radionuclide or a radionuclide-containing complex,a protein (e.g., an enzyme, a toxin, or an antibody) or a cytotoxicagent. For example, the peptide is linked or conjugated to an effectormoiety that facilitates peptide detection and/or purification and/orcomprises therapeutic properties. In one aspect, the TFPI-bindingpeptide or peptide conjugate is administered to a mammal to target aTFPI-displaying cell within the mammal. Optionally, the method furthercomprises detecting binding of the TFPI-binding peptide to TFPI. Themethod is useful for therapy and diagnostic of disease where TFPI is asuitable diagnostic marker or TFPI-expressing cells are a target for atherapeutic approach.

In some aspects, peptide-TFPI binding is detected indirectly. In thisregard, the peptide is contacted with an interaction partner that bindsthe peptide of invention without significantly interfering withpeptide-TFPI binding, and the interaction partner is detected. Exemplaryinteraction partners include, but are not limited to, antibodies,antigen-binding antibody fragments, anticalins and antibody mimetics,aptamers, and spiegelmers. Optionally, the interaction partner comprisesa detection moiety to facilitate detection of an interactionpartner-peptide complex. Methods of detecting, e.g., antibodies andfragments thereof, are well understood in the art. Similarly, detectionmoieties are widely used in the art to identify biological substancesand include, for example, dye (e.g., fluorescent dye), radionuclides andradionuclide-containing complexes, and enzymes.

Thus, the invention provides a method for diagnosing a subject sufferingfrom a disease or disorder, or at risk of suffering from a disease ordisorder, wherein the disease or disorder is associated with or causedby aberrant TFPI activity. The method comprises administering to thesubject the TFPI-binding peptide of the invention and detecting theTFPI-peptide complex. In some instances, the peptide of the invention isconjugated to a detectable moiety, and the method comprises detectingthe detectable moiety. In other instances, the method comprisesadministering to the subject a TFPI-binding peptide interaction partnerthat binds the TFPI-binding peptide, and detecting the interactionpartner. If desired, the interaction partner comprises or is conjugatedto a detectable moiety, and the detectable moiety is detected. Thepresence of the detectable moiety indicates the presence of TFPI,thereby allowing diagnosis of a disease or disorder associated with TFPI(e.g., a disease or disorder which (i) can be treated by inhibiting TFPIor (ii) comprises symptoms which can be ameliorated or prevented byinhibiting TFPI). If administration of the peptide to the subject is notdesired, a biological sample is obtained from the subject, contactedwith the TFPI-binding peptide as described herein, and TFPI-peptidecomplexes are detected.

The peptides of the invention bind TFPI and, therefore, are useful forpurifying TFPI or recombinant TFPI from a biological sample (e.g., abiological fluid, such as serum), fermentation extract, tissuepreparations, culture medium, and the like. The invention includesmethods of using the TFPI-binding in the commercial production of TFPIor in a method of characterizing TFPI molecules. For example, theinvention includes a method of purifying TFPI. The method comprisescontacting a sample containing TFPI with a peptide as defined hereinunder conditions appropriate to form a complex between TFPI and thepeptide; removing the complex from the sample; and, optionally,dissociating the complex to release TFPI. Exemplary conditionsappropriate to form a complex between TFPI and the peptide are disclosedin the Examples, and such conditions can be easily modified todissociate the TFPI-peptide complex. In some embodiments, the peptide isimmobilized to a support, e.g., a solid support, to facilitate recoveryof TFPI. For example, in one embodiment, the peptide is immobilized tochromatography stationary phase (e.g., silica, affinity chromatographybeads, or chromatography resins), a sample comprising TFPI is applied tothe stationary phase such that TFPI-peptide complexes are formed, theremainder of the sample is removed from the stationary phase, and TFPIis eluted from the stationary phase. In this regard, the peptides of theinvention are, in one aspect, suitable for use in affinitychromatography techniques.

A method of enhancing thrombin formation in a clotting factor-deficientsubject also is provided. The method comprises administering to thesubject a peptide provided herein under conditions effective to inhibitTFPI. In this regard, the TFPI-inhibitory peptide is administered in anamount and under conditions effective to enhance thrombin formation inthe subject. By “clotting factor-deficient” is meant that the subjectsuffers from a deficiency in one or more blood factors required forthrombin formation, such as FVIII, FIX, or FXI. Indeed, in oneembodiment, the subject is deficient in FVIII. Alternatively or inaddition, the subject is deficient in Factor IX. Clotting factordeficiencies are identified by examining the amount of factor in aclinical sample. Practitioners classify hemophilia according to themagnitude of clotting factor deficiency. Subjects suffering from mildhemophilia have approximately 5% to 30% of the normal amount (1 U/ml) ofFactor VIII or Factor IX. Moderate hemophilia is characterized byapproximately 1% to 5% of normal Factor VIII, Factor IX, or Factor XIlevels, while subjects suffering from severe hemophilia have less than1% of the normal amount of Factor VIII, Factor IX, or Factor XI.Deficiencies can be identified indirectly by activated partialthromboplastin time (APTT) testing. APTT testing measures the length oftime required for a blood clot to form, which is longer for patientswith Factor VIII Deficiency (hemophilia A), Factor IX Deficiency(hemophilia B), and Factor XI Deficiency (hemophilia C) compared topatients with normal clotting factor levels. Almost 100% of patientswith severe and moderate Factor VIII deficiency can be diagnosed with anAPTT. The invention further includes enhancing thrombin formation in asubject that does not suffer from a clotting factor deficiency. Themethod comprises administering to a subject (e.g., a subject comprisingnormal, physiological levels of clotting factor) a peptide providedherein under conditions effective to enhance thrombin formation.

In one aspect, the TFPI-inhibitory peptide is used for increasing bloodclot formation in a subject. The method of increasing blood clotformation comprises administering to the subject a peptide describedherein in an amount and under conditions effective to increase bloodclot formation. It will be appreciated that the method need notcompletely restore the coagulation cascade to achieve a beneficial(e.g., therapeutic) effect. Any enhancement or increase in thrombin orblood clot formation that reduces the onset or severity of symptomsassociated with clotting factor deficiencies is contemplated. Methods ofdetermining the efficacy of the method in promoting thrombin formationand blood clotting are known in the art and described herein.

The invention further includes a method of treating a blood coagulationdisorder in a subject, the method comprising administering to thesubject one or more TFPI-inhibitory peptides, such as any one or more ofthe peptides described herein, in an amount and under conditionseffective to treat the blood coagulation disorder in the subject. In oneaspect, the peptide is not a naturally-occurring peptide that inhibitsTFPI activity. “Coagulation disorders” include bleeding disorders causedby deficient blood coagulation factor activity and deficient plateletactivity. Blood coagulation factors include, but are not limited to,Factor V (FV), FVII, FVIII, FIX, FX, FXI, FXIII, FII (responsible forhypoprothrombinemia), and von Willebrand's factor. Factor deficienciesare caused by, for instance, a shortened in vivo-half-life of thefactor, altered binding properties of the factor, genetic defects of thefactor, and a reduced plasma concentration of the factor. Coagulationdisorders can be congenital or acquired. Potential genetic defectsinclude deletions, additions and/or substitution within a nucleotidesequence encoding a clotting factor whose absence, presence, and/orsubstitution, respectively, has a negative impact on the clottingfactor's activity. Coagulation disorders also stem from development ofinhibitors or autoimmunity (e.g., antibodies) against clotting factors.In one example, the coagulation disorder is hemophilia A. Alternatively,the coagulation disorder is hemophilia B or hemophilia C.

Platelet disorders are caused by deficient platelet function orabnormally low platelet number in circulation. Low platelet count may bedue to, for instance, underproduction, platelet sequestration, oruncontrolled patent destruction. Thrombocytopenia (plateletdeficiencies) may be present for various reasons, including chemotherapyand other drug therapy, radiation therapy, surgery, accidental bloodloss, and other disease conditions. Exemplary disease conditions thatinvolve thrombocytopenia are: aplastic anemia; idiopathic or immunethrombocytopenia (ITP), including idiopathic thrombocytopenic purpuraassociated with breast cancer; HIV-associated ITP and HIV-relatedthrombotic thrombocytopenic purpura; metastatic tumors which result inthrombocytopenia; systemic lupus erythematosus, including neonatal lupussyndrome splenomegaly; Fanconi's syndrome; vitamin B12 deficiency; folicacid deficiency; May-Hegglin anomaly; Wiskott-Aldrich syndrome; chronicliver disease; myelodysplastic syndrome associated withthrombocytopenia; paroxysmal nocturnal hemoglobinuria; acute profoundthrombocytopenia following C7E3 Fab (Abciximab) therapy; alloimmunethrombocytopenia, including maternal alloimmune thrombocytopenia;thrombocytopenia associated with antiphospholipid antibodies andthrombosis; autoimmune thrombocytopenia; drug-induced immunethrombocytopenia, including carboplatin-induced thrombocytopenia andheparin-induced thrombocytopenia; fetal thrombocytopenia; gestationalthrombocytopenia; Hughes' syndrome; lupoid thrombocytopenia; accidentaland/or massive blood loss; myeloproliferative disorders;thrombocytopenia in patients with malignancies; thromboticthrombocytopenia purpura, including thrombotic microangiopathymanifesting as thrombotic thrombocytopenic purpura/hemolytic uremicsyndrome in cancer patients; post-transfusion purpura (PTP); autoimmunehemolytic anemia; occult jejunal diverticulum perforation; pure red cellaplasia; autoimmune thrombocytopenia; nephropathia epidemica;rifampicin-associated acute renal failure; Paris-Trousseauthrombocytopenia; neonatal alloimmune thrombocytopenia; paroxysmalnocturnal hemoglobinuria; hematologic changes in stomach cancer;hemolytic uremic syndromes (e.g., uremic conditions in childhood); andhematologic manifestations related to viral infection includinghepatitis A virus and CMV-associated thrombocytopenia. Plateletdisorders also include, but are not limited to, Von Willebrand Disease,paraneoplastic platelet dysfunction, Glanzman's thrombasthenia, andBernard-Soulier disease. Additional bleeding disorders amenable totreatment with a TFPI-inhibitory peptide include, but are not limitedto, hemorrhagic conditions induced by trauma; a deficiency in one ormore contact factors, such as FXI, FXII, prekallikrein, and highmolecular weight kininogen (HMWK); vitamin K deficiency; a fibrinogendisorder, including afibrinogenemia, hypofibrinogenemia, anddysfibrinogenemia; and alpha2-antiplasmin deficiency. In one embodiment,the TFPI-inhibitory peptide is used to treat excessive bleeding, such asexcessive bleeding caused by surgery, trauma, intracerebral hemorrhage,liver disease, renal disease, thrombocytopenia, platelet dysfunction,hematomas, internal hemorrhage, hemarthroses, hypothermia, menstruation,pregnancy, and Dengue hemorrhagic fever. All of the above are considered“blood coagulation disorders” in the context of the disclosure.

In one aspect, the TFPI-inhibitory peptide of the invention is used toreverse the effects (in whole or in part) of one or more anticoagulantsin a subject. Numerous anticoagulants are known in the art and include,for instance, heparin; coumarin derivatives, such as warfarin ordicumarol; TFPI; AT III; lupus anticoagulant; nematode anticoagulantpeptide (NAPc2); FVIIa inhibitors; active-site blocked FVIIa (FVIIai);active-site blocked FIXa (FIXai); FIXa inhibitors; FXa inhibitors,including fondaparinux, idraparinux, DX-9065a, and razaxaban (DPC906);active-site blocked FXa (FXai); inhibitors of FVa or FVIIIa, includingactivated protein C (APC) and soluble thrombomodulin; thrombininhibitors, including hirudin, bivalirudin, argatroban, andximelagatran; and antibodies or antibody fragments that bind a clottingfactor (e.g., FV, FVII, FVIII, FIX, FX, FXIII, FII, FXI, FXII, vonWillebrand factor, prekallikrein, or high molecular weight kininogen(HMWK)).

As used herein, “treating” and “treatment” refers to any reduction inthe severity and/or onset of symptoms associated with a bloodcoagulation disorder. Accordingly, “treating” and “treatment” includestherapeutic and prophylactic measures. One of ordinary skill in the artwill appreciate that any degree of protection from, or amelioration of,a blood coagulation disorder or symptom associated therewith isbeneficial to a subject, such as a human patient. The quality of life ofa patient is improved by reducing to any degree the severity of symptomsin a subject and/or delaying the appearance of symptoms. Accordingly,the method in one aspect is performed as soon as possible after it hasbeen determined that a subject is at risk for developing a bloodcoagulation disorder (e.g., a deficiency in a clotting factor (e.g.,FVIII, FIX, or FXI) is detected) or as soon as possible after a bloodcoagulation disorder (e.g., hemophilia A, hemophilia B, or hemophilia C)is detected. In an additional aspect, the peptide is administered toprotect, in whole or in part, against excessive blood loss during injuryor surgery.

In view of the above, the invention provides a peptide for use in amethod for the treatment of a subject, such as a method for thetreatment of a disease where the inhibition of TFPI is beneficial. Inone aspect, the disease or disorder is a blood coagulation disorder. Thesubject is suffering from a disease or disorder or is at risk fromsuffering from a disease or disorder (or adverse biological event, suchas excessive blood loss). The method comprises administering to thesubject the peptide of the invention in an amount and under conditionseffective to treat or prevent, in whole or in part, the disease ordisorder. The invention further provides a peptide for use in themanufacture of a medicament. For example, the peptide can be used in themanufacture of a medicament for the treatment of a blood coagulationdisorder, as described in detail herein.

In some embodiments, it is advantageous to administer to a subject anucleic acid comprising a nucleic acid sequence encoding a TFPI-bindingpeptide (e.g., TFPI-inhibitory peptide) of the invention. Such a nucleicacid, in one aspect, is provided instead of, or in addition to, aTFPI-inhibitory peptide. Expression vectors, nucleic acid regulatorysequences, administration methods, and the like, are further describedherein and in U.S. Patent Publication No. 20030045498.

A particular administration regimen for a particular subject willdepend, in part, upon the TFPI-inhibitory peptide of the invention used,the amount of TFPT-binding peptide (e.g., TFPI-inhibitory peptide)administered, the route of administration, the particular ailment beingtreated, considerations relevant to the recipient, and the cause andextent of any side effects. The amount of peptide administered to asubject (e.g., a mammal, such as a human) and the conditions ofadministration (e.g., timing of administration, route of administration,dosage regimen) are sufficient to effect the desired biological responseover a reasonable time frame. Dosage typically depends upon a variety offactors, including the particular TFPI-inhibitory peptide employed, theage and body weight of the subject, as well as the existence andseverity of any disease or disorder in the subject. The size of the dosealso will be determined by the route, timing, and frequency ofadministration. Accordingly, the clinician may titer the dosage andmodify the route of administration to obtain the optimal therapeuticeffect, and conventional range-finding techniques are known to those ofordinary skill in the art. Purely by way of illustration, in one aspect,the method comprises administering, e.g., from about 0.1 μg/kg to about100 mg/kg or more, depending on the factors mentioned above. In otherembodiments, the dosage may range from 1 μg/kg up to about 75 mg/kg; or5 μg/kg up to about 50 mg/kg; or 10 μg/kg up to about 20 mg/kg. Incertain embodiments, the dose comprises about 0.5 mg/kg to about 20mg/kg (e.g., about 1 mg/kg, 1.5 mg/kg, 2 mg/kg, 2.3 mg/kg, 2.5 mg/kg, 3mg/kg, 3.5 mg/kg, 4 mg/kg, 4.5 mg/kg, 5 mg/kg, 5.5 mg/kg, 6 mg/kg, 6.5mg/kg, 7 mg/kg, 8 mg/kg, 9 mg/kg, or 10 mg/kg) of peptide. Given thechronic nature of many blood coagulation disorders, it is envisionedthat a subject will receive the TFPI-inhibitory peptide over a treatmentcourse lasting weeks, months, or years, and may require one or moredoses daily or weekly. In other embodiments, the TFPI-inhibitory peptideis administered to treat an acute condition (e.g., bleeding caused bysurgery or trauma, or factor inhibitor/autoimmune episodes in subjectsreceiving coagulation replacement therapy) for a relatively shorttreatment period, e.g., one to 14 days.

Suitable methods of administering a physiologically-acceptablecomposition, such as a pharmaceutical composition comprising a peptidedescribed herein, are well known in the art. Although more than oneroute can be used to administer a peptide, a particular route canprovide a more immediate and more effective reaction than another route.Depending on the circumstances, a pharmaceutical composition is appliedor instilled into body cavities, absorbed through the skin or mucousmembranes, ingested, inhaled, and/or introduced into circulation. In oneaspect, a composition comprising a TFPI-inhibitory peptide isadministered intravenously, intraarterially, or intraperitoneally tointroduce the peptide of the invention into circulation. Non-intravenousadministration also is appropriate, particularly with respect to lowmolecular weight therapeutics. In certain circumstances, it is desirableto deliver a pharmaceutical composition comprising the TFPI-inhibitorypeptide orally, topically, sublingually, vaginally, rectally; throughinjection by intracerebral (intra-parenchymal), intracerebroventricular,intramuscular, intra-ocular, intraportal, intralesional, intramedullary,intrathecal, intraventricular, transdermal, subcutaneous, intranasal,urethral, or enteral means; by sustained release systems; or byimplantation devices. If desired, the TFPI-inhibitory peptide isadministered regionally via intraarterial or intravenous administrationfeeding a region of interest, e.g., via the femoral artery for deliveryto the leg. In one embodiment, the peptide is incorporated into amicroparticle as described in, for example, U.S. Pat. Nos. 5,439,686 and5,498,421, and U.S. Patent Publications 2003/0059474, 2003/0064033,2004/0043077, 2005/0048127, 2005/0170005, 2005/0142205, 2005/142201,2005/0233945, 2005/0147689. 2005/0142206, 2006/0024379, 2006/0260777,2007/0207210, 2007/0092452, 2007/0281031, and 2008/0026068.Alternatively, the composition is administered via implantation of amembrane, sponge, or another appropriate material on to which thedesired molecule has been absorbed or encapsulated. Where animplantation device is used, the device in one aspect is implanted intoany suitable tissue, and delivery of the desired molecule is in variousaspects via diffusion, timed-release bolus, or continuousadministration. In other aspects, the TFPI-inhibitory peptide isadministered directly to exposed tissue during surgical procedures ortreatment of injury, or is administered via transfusion of bloodprocedures. Therapeutic delivery approaches are well known to theskilled artisan, some of which are further described, for example, inU.S. Pat. No. 5,399,363.

To facilitate administration, the TFPI-binding peptide (e.g.,TFPI-inhibitory peptide) in one embodiment is formulated into aphysiologically-acceptable composition comprising a carrier (i.e.,vehicle, adjuvant, buffer, or diluent). The particular carrier employedis limited only by chemico-physical considerations, such as solubilityand lack of reactivity with the peptide, and by the route ofadministration. Physiologically-acceptable carriers are well known inthe art. Illustrative pharmaceutical forms suitable for injectable useinclude without limitation sterile aqueous solutions or dispersions andsterile powders for the extemporaneous preparation of sterile injectablesolutions or dispersions (for example, see U.S. Pat. No. 5,466,468).Injectable formulations are further described in, e.g., Pharmaceuticsand Pharmacy Practice, J. B. Lippincott Co., Philadelphia. Pa., Bankerand Chalmers. eds., pages 238-250 (1982), and ASHP Handbook onInjectable Drugs, Toissel, 4th ed., pages 622-630 (1986)). Apharmaceutical composition comprising a peptide provided herein isoptionally placed within containers, along with packaging material thatprovides instructions regarding the use of such pharmaceuticalcompositions. Generally, such instructions include a tangible expressiondescribing the reagent concentration, as well as, in certainembodiments, relative amounts of excipient ingredients or diluents thatmay be necessary to reconstitute the pharmaceutical composition.

When appropriate, the TFPI-binding peptide (e.g., TFPI-inhibitorypeptide) of the invention is administered in combination with othersubstances and/or other therapeutic modalities to achieve an additionalor augmented biological effect. Co-treatments include, but are notlimited to, plasma-derived or recombinant coagulation factors,hemophilia prophylaxis treatments, immunosuppressants, plasmafactor-inhibiting antibody antagonists (i.e., anti-inhibitors),antifibrinolytics, antibiotics, hormone therapy, anti-inflammatoryagents (e.g., Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) orsteroidal anti-inflammatory substances), procoagulants, and painrelievers. In one aspect, the method is an adjunct therapy totraditional replacement factor treatment regimens involvingadministration of, e.g., FXIII, FXII, FXI (e.g., HEMOLEVEN® (Laboratoirefrancais du Fractionnement et des Biotechnologies, Les Ulis, France) andFXI concentrate (BioProducts Laboratory, Elstree, Hertfordshire, UK)),FX, FIX (e.g., BENEFIX® Coagulation Factor IX (Wyeth, Madison, N.J.);ALPHANINE® SD (Grifols, Los Angeles, Calif.); MONONINE® (CSL Behring,King of Prussia, Pa.); BEBULIN-VH™ (Baxter, Deerfield, Ill.);PROFILNINE® SD (Grifols, Los Angeles, Calif.); or PROPLEX T™ (Baxter,Deerfield, Ill.)), FVIII (e.g., ADVATE™ (Baxter, Deerfield, Ill.);HELIXATE® FS(CSL Behring, King of Prussia, Pa.); REFACTO® (Wyeth,Madison, N.J.), XYNTHA™ (Wyeth, Madison, N.J.), KOGENATE® and KOGENATE®FS (Bayer, Pittsburgh, Pa.); ALPHANATE® (Grifols, Los Angeles, Calif.);HEMOPHIL M™ (Baxter, Deerfield, Ill.); KOATE®-DVT (TalecrisBiotherapeutics-USA, Research Triangle Park, N.C.); or MONARC-M™(Baxter, Deerfield, Ill.)), FVIIa (e.g., NOVOSEVEN® FVIIa (Novo Nordisk,Princeton, N.J.) and FVII concentrate (Baxter Bioscience, Vienna,Austria, or BioProducts Laboratory, Elstree, Hertfordshire, UK)), FV,FVa, FII, and/or FIII, to a subject. In some instances, the subject alsoreceives FEIBA VH Immuno™ (Baxter BioScience, Vienna, Austria), which isa freeze-dried sterile human plasma fraction with Factor VIII inhibitorbypassing activity. FEIBA VH Immuno™ contains approximately equal unitsof Factor VIII inhibitor bypassing activity and Prothrombin ComplexFactors (Factors II, VII, IX, and X and protein C). Other exemplaryco-treatments include, but are not limited to, prekallikrein, highmolecular weight kininogen (HMWK), Von Willebrand's factor, TissueFactor, and thrombin. Alternatively or in addition, the TFPI-inhibitorypeptide is co-formulated with one or more different TFPI-inhibitorypeptides.

The invention thus includes administering to a subject a TFPI-bindingpeptide (e.g., TFPI-inhibitory peptide) of the invention (or multipleTFPI-inhibitory peptides), in combination with one or more additionallysuitable substances(s), each being administered according to a regimensuitable for that medicament. Administration strategies includeconcurrent administration (i.e., substantially simultaneousadministration) and non-concurrent administration (i.e., administrationat different times, in any order, whether overlapping or not) of theTFPI-inhibitory peptide and one or more additionally suitable agents(s).It will be appreciated that different components are optionallyadministered in the same or in separate compositions, and by the same ordifferent routes of administration.

In some embodiments, the peptide of the invention is conjugated to amoiety, e.g., a therapeutic or diagnostic moiety, such as the detectionmoieties and co-treatments described above. Alternatively or inaddition, the peptide is administered in combination with an interactionpartner (e.g., an antibody, antibody fragment, anticalin, aptamer, orspiegelmer) that (a) binds the peptide and (b) is therapeutically activeand/or is linked to a moiety that provides additional functionality tothe interaction partner (e.g., a therapeutic, diagnostic, or detectionagent). Suitable moieties include, but are not limited to, dyes,radionuclides, radionuclide-containing complexes, enzymes, toxins,antibodies, antibody fragments, and cytotoxic agents, and, in someinstances, the moiety possesses therapeutic activity (i.e., achieves anadvantageous or desired biological effect). The peptide conjugates orpeptide-interaction partner pair is suitable for use in any of themethods described herein, such as methods of treating a subjectsuffering from a disease or disorder or at risk of suffering from adisease or disorder.

All publications, patents and patent applications cited in thisspecification are herein incorporated by reference as if each individualpublication or patent application were specifically and individuallyindicated to be incorporated by reference. In addition, the entiredocument is intended to be related as a unified disclosure, and itshould be understood that all combinations of features described hereinare contemplated, even if the combination of features are not foundtogether in the same sentence, or paragraph, or section of thisdocument. For example, where protein therapy is described, embodimentsinvolving polynucleotide therapy (using polynucleotides/vectors thatencode the protein) are specifically contemplated, and the reverse alsois true. Although the foregoing invention has been described in somedetail by way of illustration and example for purposes of clarity ofunderstanding, it will be readily apparent to those of ordinary skill inthe art in light of the teachings of this invention that certain changesand modifications may be made thereto without departing from the spiritor scope of the appended claims. The invention includes, for instance,all embodiments of the invention narrower in scope in any way than thevariations specifically mentioned above. With respect to aspects of theinvention described as a genus, all individual species are individuallyconsidered separate aspects of the invention. With respect to aspects ofthe invention described or claimed with “a” or “an,” it should beunderstood that these terms mean “one or more” unless contextunambiguously requires a more restricted meaning. With respect toelements described as one or more within a set, it should be understoodthat all combinations within the set are contemplated.

EXAMPLES Example 1

The following example describes production, identification, andscreening of peptides for binding to TFPI.

Peptides candidates were obtained from commercial suppliers (e.g.,PolyPeptide Laboratories SAS (Strasbourg, France) and JPT PeptideTechnologies GmbH (Berlin, Germany)). Methods for synthesizing candidatepeptides are provided above. Candidate peptides were synthesized astrifluoroacetate (TFA) salts with a purity >90% or >60%. All peptideswere solved in DMSO to a stock concentration of 10 mM. TFPI-bindingpeptide sequences were identified using an mRNA display library. ThemRNA display technology is superior to other library screeningtechniques for allowing for a diversity of 10¹⁴ different sequenceswithin a starting pool and avoiding, e.g., the in vivo steps requiredfor phage display. In brief, the technology involves directly linkingmRNA to its encoded candidate peptide through a puromycin molecule (FIG.5). The mRNA display method is further described in International PatentPublication No. WO 2005/051985 and Liu et al., Methods in Enzymology,318, 268-293 (2000). TFPI was immobilized to a solid support via biotinand exposed to candidate peptide-RNA complexes. TFPI-bound candidatepeptide-RNA complexes were isolated, and the RNA reverse transcribed toobtain coding DNA. High affinity binders were obtained following six toten selection rounds using a competitive elusion strategy. Many of thecandidate peptides were 31 amino acids in length (27 randomized aminoacids and 2 amino acids flanking both termini).

Selected peptides were synthesized and subjected to peptide optimizationusing a microarray-based scan analysis to identify peptide fragmentsretaining TFPI-binding affinity. For example, a microarray-based scan ofJBT0047 was performed using a series of 20 amino acid fragments of thepeptide, the sequences of which overlapped by 19 amino acids. N- andC-terminal truncation analysis supplemented the scan analysis. Themicroarray scan results demonstrated that that peptide JBT0293 boundTFPI with the highest affinity. A series of substitution mutants basedon the amino acid sequence of JBT0293 was generated and tested for TFPIbinding properties.

The affinity of a subset of peptides for TFPI was demonstrated via anenzyme-linked immunosorbent assay (ELISA)-like assay (binding (EC₅₀)ELISA) performed with biotinylated peptides. Ninety-six well MaxiSorpplates (Nunc) were coated with 3 μg/mL TFPI in coating buffer (15 mMNa₂CO₃, 35 mM NaHCO₃, pH 9.6) over night. Plates were washed three timeswith 350 μl wash buffer (HNaT: 175 mM NaCl, 25 mM HEPES, 5 mM CaCl₂,0.1% Tween 80, pH 7.35), and subsequently blocked with 200 μl 2% yeastextract in HNaT for 2 hours. Plates were then washed three times with350 μl HNaT. Biotinylated candidate peptides were diluted from a DMSOstock 1/200 in HNaT. The initial peptide concentration was 50 μM if noprecipitate appeared during the 1/200 dilution of the 10 mM peptidestock solution. Pre-dilutions of the peptide stock in DMSO wereconducted if precipitates formed. The diluted peptides were applied tothe Maxisorp plates, serial dilutions (⅓) were generated, and thedilutions were incubated for 1.5 hours at room temperature. Incubationwas followed by three wash steps (350 μl HNaT). Bound peptide wasdetected by incubation with horseradish peroxidase-conjugatedstreptavidin (1 hour), followed by three wash steps with HNaT and asubsequent chromogenic conversion of added TMB(3,3′5,5′-Tetramethylbenzidin). The assay is illustrated in FIG. 6A.

Generally, peptide binding to immobilized TFPI was significantly abovebackground. EC₅₀ values for biotinylated peptides are given in FIGS.32-39. The binding curve of one TFPI-binding peptide, JBT0132, isdepicted in FIG. 7. The EC₅₀ of JBT0132 was calculated to be about 2.2nM.

In addition, a competition (IC₅₀) ELISA was performed using biotinylatedTFPI-binding peptides as “tracers” to compete for TFPI-binding withnon-biotinylated candidate peptides. The assay principle is depicted inFIG. 6B. Ninety-six well MaxiSorp plates (Nunc) were coated with 3 μg/mLTFPI in coating buffer (15 mM Na₂CO₃, 35 mM NaHCO₃, pH 9.6) over night.Plates were washed three times with 350 μl wash buffer (HNaT: 175 mMNaCl, 25 mM HEPES, 5 mM CaCl₂, 0.1% Tween 80, pH 7.35), and blocked with200 μl 2% yeast extract in HNaT for 2 hours. Plates were then washedthree times with 350 μl HNaT. Biotinylated tracer peptides were appliedat a concentration corresponding to their respective EC₉₀ valuesdetermined in the binding ELISA (median if n>2). A competitor stocksolution of peptide (10 mM) was diluted 1/33.3 in HNaT without HSA, anda serial ⅓ dilution was prepared with HNaT with 3% DMSO. The dilutionwas further diluted with the biotinylated tracer peptide in a ratio of1:6 (20 μl competitor dilution and 100 μl tracer peptide). The mixtureof competitor and tracer peptide was applied to the TFPI-coatedmicrotiter plate and incubated for 1.5 hours. The plates were washedthree times with 350 μl HNaT. Peptide-TFPI binding was detected byapplying HRP-conjugated streptavidin to the microtiter plate, incubatingthe mixture for one hour, washing the plate three times with 350 μlHNaT, applying TMB (3,3′5,5′-Tetramethylbenzidin), and detecting thesubsequent chromogenic conversion of TMB by HRP. IC₅₀ graphs forrepresentative non-biotinylated peptides are provided in FIGS. 8A-8D.IC₅₀ measurements of peptides JBT0303, JBT0120, and JBT0224 are setforth in Table 3.

TABLE 3 Tracer Concentration Peptide IC₅₀ [μM] n SD Tracer Peptide [μM]JBT0303 0.119  2 0.064 JBT0131 0.0409 JBT0120 0.0189 3 0.0044 JBT01240.0718 JBT0224 n.a. 1 JBT0126 0.240

In addition to the competition ELISA (IC₅₀) assay, a screening assay wasemployed to measure higher numbers of peptides in parallel. Thescreening ELISA is similar to the competition IC₅₀ ELISA with theexception that only three different concentrations of the competitorwere employed (300 nM, 100 nM and 33.3 nM for the JBT0047 class, and50000 nM, 16667 nM and 5556 nM for the JBT0122 class). In someinstances, screening results were expressed as percent inhibition of thetracer signal in relation to a competitive peptide (competitive peptideJBT0477 for the JBT0047 family, and competitive peptide JBT1697 for theJBT0122 family). The competition IC₅₀ assay results and the screeningassay results of peptides prepared and screened in accordance with themethods set forth herein are provided in FIGS. 32-39. The mean IC₅₀values presented in FIGS. 32-39 are based on a greater number of assaysthan the values presented in Table 3 and, therefore, the values maydiffer slightly. The results of the screening ELISA are presented aspercent inhibition of tracer peptide JBT0131 binding. Several peptidesthat were analyzed using the IC₅₀ ELISA are classified in FIGS. 32-39according to their binding affinity as set forth in Table 4.

TABLE 4 TFPI competition ELISA IC₅₀ [nM] Group <50 nM A 50 ≦ x < 100 nMB 100 ≦ x < 250 nM C 250 ≦ x < 1000 nM D 1000 ≦ x < 5000 nM E 5000 ≦ x <10000 nM F 10000 ≦ x < 50000 nM G

Exemplary TFPI-binding peptides identified using the methods describedherein are presented in Table 5. Some peptides were biotinylated, andmany comprise N- and C-terminal lysines to promote solubility. Severalpeptides exhibited TFPI-inhibitory activity in model and/or plasmaticassay systems, as described below.

TABLE 5 Peptide Parent Sequence SEQ ID JBT0047 QSKKNVFVFGYFERLRAK 1JBT0047 JBT0047 Ac-SGVGRLQAFQSKKNVFVFGYFERLRAKLTS-NH2 253 JBT0051JBT0047 Biotinyl-Ttds-SGVGRLQVAFQSKKNVFVFGYFERLRAKLTS-NH2 962 JBT0055JBT0047 Ac-SGVGRLQVAFQSKKNVFVFGYFERLRAKLTS-Ttds-Lys(Biotinyl)-NH2 963JBT0131 JBT0047 Biotinyl-Ttds-AFQSKKNVFVFGYFERLRAK-NH2 964 JBT0132JBT0047 Biotinyl-Ttds-FQSKKNVFVFGYFERLRAKL-NH2 965 JBT0133 JBT0047Biotinyl-Ttds-QSKKNVFVFGYFERLRAKLT-NH2 966 JBT0155 JBT0047Ac-KKSGVGRLQVAFQSKKNVFVFGYFERLRAKLTSKK-NH2 8 JBT0158 JBT0047Ac-KKSGVGRLQVAFQSKKNVFVFGYFERLRAKKK-NH2 9 JBT0162 JBT0047Ac-KKGRLQVAFQSKKNVFVFGYFERLRAKLTSKK-NH2 10 JBT0163 JBT0047Ac-KKQVAFQSKKNVFVFGYFERLRAKLTSKK-NH2 11 JBT0164 JBT0047Ac-KKFQSKKNVFVFGYFERLRAKLTSKK-NH2 12 JBT0166 JBT0047Biotinyl-Ttds-KKFQSKKNVFVFGYFERLRAKLKK-NH2 968 JBT0169 JBT0047Ac-KKAFQSKKNVFVFGYFERLRAKKK-NH2 254 JBT0170 JBT0047Ac-KKFQSKKNVFVFGYFERLRAKLKK-NH2 13 JBT0171 JBT0047Ac-KKQSKKNVFVFGYFERLRAKLTKK-NH2 255 JBT0174 JBT0047Ac-KKAFQSKKNVFVFGYFERLRAKLKK-NH2 14 JBT0175 JBT0047Ac-KKAFQSKKNVFVFGYFERLRAKLTKK-NH2 182 JBT0293 JBT0047Ac-FQSKKNVFVFGYFERLRAKL-NH2 256 X₃X₄X₅KX₇NVFX₁₁X₁₂GYX₁₅X₁₆RLRAKX₂₂ 2JBT0294 JBT0047 Ac-YQSKKNVFVFGYFERLRAKL-NH2 257 JBT0295 JBT0047Ac-FSSKKNVFVFGYFERLRAKL-NH2 713 JBT0296 JBT0047Ac-FQNKKNVFVFGYFERLRAKL-NH2 407 JBT0297 JBT0047Ac-FQSKNNVFVFGYFERLRAKL-NH2 183 JBT0298 JBT0047Ac-FQSKQNVFVFGYFERLRAKL-NH2 747 JBT0299 JBT0047Ac-FQSKKNVFAFGYFERLRAKL-NH2 408 JBT0300 JBT0047Ac-FQSKKNVFSFGYFERLRAKL-NH2 409 JBT0301 JBT0047Ac-FQSKKNVFTFQYFERLRAKL-NH2 470 JBT0302 JBT0047Ac-FQSKKNVFVAGYFERLRAKL-NH2 258 JBT0303 JBT0047Ac-FQSKKNVFVDGYFERLRAKL-NH2 184 JBT0304 JBT0047Ac-FQSKKNVFVLGYFERLRAKL-NH2 259 JBT0305 JBT0047Ac-FQSKKNVFVQGYFERLRAKL-NH2 260 JBT0306 JBT0047Ac-FQSKKNVFVSGYFERLRAKL-NH2 185 JBT0307 JBT0047Ac-FQSKKNVFVYGYFERLRAKL-NH2 261 JBT0308 JBT0047Ac-FQSKKNVFVFGYKERLRAKL-NH2 411 JBT0309 JBT0047Ac-FQSKKNVFVFGYYERLRAKL-NH2 412 JBT0310 JBT0047Ac-FQSKKNVFVFGYFDRLRAKL-NH2 262 JBT0311 JBT0047Ac-FQSKKNVFVFGYFERLRAKN-NH2 748 TFVDERLLYFLTIGNMGMYAAQLKF 3 JBT0049JBT0049 Ac-SGNTFVDERLLYFLTIGNMGMYAAQLKFRTS-NH2 3025 JBT0053 JBT0049Biotinyl-Ttds-SGNTFVDERLLYFLTIGNMGMYAAQLKFRTS-NH2 3006 JBT0057 TBT0049Ac-SGNTFVDERLLYFLTIGNMGMYAAQLKFRTS-Ttds-Lysin(biotin)-NH2 3018 JBT0190JBT0049 Ac-KKSGNTFVDERLLYFLTIGNMGMYAAQLKFRTSKK-NH2 3031 JBT0193 JBT0049Ac-KKSGNTFVDERLLYFLTIGNMGMYAAQLKFKK-NH2 3073 JBT0197 JBT0049Ac-KKTFVDERLLYFLTIGNMGMYAAQLKFRTSKK-NH2 3076 VIVFTFRHNKLIGYERRY 4JBT0050 JBT0050 Ac-AGRGCTKVIVFTFRHNKLIGYERRYNCTS-NH2 3047 JBT0054JBT0050 Biotinyl-Ttds-SGRGCTKVIVFTFRHNKLIGYERRYNCTS-NH2 3002 JBT0058JBT0050 Ac-SGRGCTKVIVFTFRHNKLIGYERRYNCTS-Ttds-Lysin(biotin)-NH2 3003JBT0129 JBT0050 Ac-SGRG[CTKVIVFTFRHNKLIGYERRYNC]TS-NH2 3026 JBT0130JBT0050 Biotinyl-Ttds-SGRG[CTKVIVFTFRHNKLIGYERRYNC]TS-NH2 3001 JBT0205JBT0050 Ac-KKSGRGCTKVIVFTFRHNKLIGYERRYNCTSKK-NH2 3029 JBT0208 JBT0050Ac-KKSGRGCTKVIVFTFRHNKLIGYERRYNKK-NH2 3027 JBT0211 JBT0050Ac-KKGCTKVIVFTFRHNKLIGYERRYNCTSKK-NH2 3032 JBT0212 JBT0050Ac-KKKVIVFTFRHNKLIGYERRYNCTSKK-NH2 3033 JBT0217 JBT0050Ac-KKTKVIVFTFRHNKLIGYERRYKK-NH2 3062 JBT0218 JBT0050Ac-KKKVIVFTFRHNKLIGYERRYNKK-NH2 3063 JBT0219 JBT0050Ac-KKVIVFTFRHNKLIGYERRYNCKK-NH2 3030 GVWQTHPRYFWTMWPDIKGEVIVLFGT 5JBT0101 JBT0101 Ac-KKSGVWQTHPRYFWTMWPDIKGEVIVLFGTSKK-NH2 3036 JBT0052JBT0101 Biotinyl-Ttds-KKSGVWQTHPRYFWTMWPDIKGEVIVLFGTSKK-NH2 3004 JBT0103JBT0101 Ac-KKSGVWQTHPRYFWTMWPDKIKGEVIVLFGTS-Ttds-KK-Lysin(biotinyl)-NH23005 JBT0178 JBT0101 Ac-KKSGVWQTHPRYFWTMWPDIKGEVIVLFGTKK-NH2 3028JBT0182 JBT0101 Ac-KKGVWQTHPRYFWTMWPDIKGEVIVLFGTSKK-NH2 3037KWFCGMRDMKGTMSCVWVKF 6 JBT0120 JBT0120Ac-SGASRYKWF[CGMRDMKGTMSC]VWVKFRYDTS-NH2 1047 JBT0124Biotinyl-Ttds-SGASRYKWF[CGMRDMKGTMSC]VWVKFRYDTS-NH2 1290 JBT0247 JBT0120Ac-SGASRYKWFCGMRDMKGTMSCVWVKFRYDTS-NH2 1213 JBT0248 JBT0120Ac-KKSGASRYKWF[CGMRDMKGTMSC]VWVKFRYDTSKK-NH2 1001 JBT0251 JBT0120Ac-KKKWFCGMRDMKGTMSCVWVKFKK-NH2 1202 JBT0252 JBT0120Ac-KKCGMRDMKGTMSCVWVKFRYDKK-NH2 1215 ASFPLAVQLHVSKRSKEMA 7 JBT0122JBT0122 Ac-SGYASFPLAVQLHVSKRSKEMALARLYYKTS-NH2 2002 JBT0126 JBT0122Biotinyl-Ttds-SGYASFPLAVQLHVSKRSKEMALARLYYKTS-NH2 2498 JBT0221 JBT0122Ac-KKSGYASFPLAVQLHVSKRSKEMALARLYYKTSKK-NH2 2003 JBT0224 JBT0122Ac-KKSGYASFPLAVQLHVSKRSKEMALARLYYKK-NH2 2298 JBT0225 JBT0122Ac-KKSGYASFPLAVQLHVSKRSKEMALARKK-NH2 2128 JBT0226 JBT0122Ac-KKSGYASFPLAVQLHVSKRSKEMAKK-NH2 2299 JBT0228 JBT0122Ac-KKASFPLAVQLHVSKRSKEMALARLYYKTSKK-NH2 2016 JBT0232 JBT0122Ac-KKGYASFPLAVQLHVSKRSKEMKK-NH2 2303 JBT0233 JBT0122Ac-KKYASFPLAVQLHVSKRSKEMAKK-NH2 2304

This example provides exemplary methods of generating and characterizingTFPI-inhibitory peptides. All peptides in Table 5 were found to bindhuman TFPI-1α. Mutation analysis demonstrated that at least one aminoacid in a TFPI-binding peptide may be substituted while retainingaffinity for TFPI. The peptides of Table 5 tested in ELISA assays boundTFPI-1α with an EC₅₀ of less than 10 μM (1×10⁻⁵ M) and an IC₅₀ of lessthan 50 μM.

Example 2

Selected TFPI-binding peptides were further characterized in terms of“anti-target” binding. This example demonstrates that TFPI-inhibitorypeptides exhibit reduced affinity for non-TFPI-1 proteins.

TFPI-2 was selected as an anti-target because of its similarity toTFPI-1. The binding kinetics of TFPI-binding peptides to human TFPI-1(residues 29-282 fused at the C-terminus to a 10 His-tag; MW 41 kDa (R&DSystems, Minneapolis, Minn.; catalog number 2974-PI)) murine TFPI-1(residues 29-289 fused at the C-terminus to a 10 His-tag; MW 41 kDa (R&DSystems; catalogue number 2975-PI)), and TFPI-2 (R&D Systems,Minneapolis, Minn.) were studied using a BIAcore 3000™ surface plasmonresonance assay (GE Healthcare, Chalfont St. Giles, UK). TFPI proteinswere immobilized on a C1 chip (GE Healthcare, Order Code: BR-1005-40) byamine coupling chemistry aiming for 500 RU. Several TFPI-bindingpeptides were employed as analytes for interacting with the immobilizedTFPI proteins. A flow rate of 30 μl/min was utilized. After 180 seconds,180 μl of peptide solution was injected at six different concentrationsranging from 3.84 nM to 656.25 nM, followed by a dissociation time of480 seconds. The chip was regenerated with 45 μl 10 mM NaOH. Eachbinding experiment was preceded and followed by four measurements withHBS-P buffer (10 mM HEPES, pH 7.4, 150 mM NaCl, 0.005% P20) plus 1% DMSOand 0.8% P80. BIAevaluation® Version 4.1 software (GE Healthcare) wasemployed to analyze the data. Sensorgrams were fitted to a 1:1 Langmuirbinding curve to determine k_(on) and k_(off) and calculate K_(D).

Certain tested peptides, e.g., JBT0050, JBT0121, JBT0205 and JBT0211,bound to the blank cell and binding constants from those sensorgramscould not be determined. JBT0133 showed weak binding to TFPI-1.Sensorgrams from other peptides gave reliable binding constants. Resultsfrom BIAcore analysis of several TFPI-inhibitory peptides is provided inTable 6 and FIGS. 19-21. Each of the peptides listed in Table 6presented a K_(D) of less than 10 μM. Sensorgrams of two of the peptidesare provided as FIGS. 9A and 9B.

TABLE 6 Peptide k_(on) (1/Ms) k_(off) (1/s) K_(D) (M) JBT0047 4.0 × 10⁵1.9 × 10⁻² 4.7 × 10⁻⁸ JBT0120 1.17 × 10⁶  4.78 × 10⁻²  4.08 × 10⁻⁸ JBT0131 1.4 × 10⁵ 6.0 × 10⁻² 4.31 × 10⁻⁷  JBT0132 3.55 × 10⁴  3.26 ×10⁻²  9.17 × 10⁻⁷  JBT0224 6.39 × 10⁴  1.95 × 10⁻²  3.05 × 10⁻⁷  JBT02936.0 × 10⁵ 5.6 × 10⁻² 9.5 × 10⁻⁸ JBT0297 5.0 × 10⁵ 1.4 × 10⁻² 2.9 × 10⁻⁸JBT0303 8.13 × 10⁵  2.75 × 10⁻²  3.4 × 10⁻⁸ JBT0305 7.5 × 10⁵ 3.1 × 10⁻²6.1 × 10⁻⁸

Interaction with the TFPI-2 anti-target also was examined. The maximumsignal generated from candidate peptide interaction with human TFPI-2was much lower than the signals obtained with TFPI-1 as an interactionpartner. Kinetic analysis of the low TFPI-2 binding signals was prone toerror; therefore, visual comparison of sensorgrams was used to estimatebinding affinity. A sensorgram illustrating JBT0120 binding to TFPI-1and TFPI-2 is provided as FIGS. 10A and 10B. JBT0120 binds TFPI-2 with10-fold lower affinity compared to its binding affinity for TFPI-1.JBT0132 also was found to exhibit at least 10-fold greater affinity forTFPI-1 than TFPI-2.

The data provided by this example confirm that TFPI-inhibitory peptidesspecifically bind TFPI-1.

Example 3

The following example describes the characterization of TFPI-inhibitoryactivity of select peptides identified in Example 1 using a FXainhibition and extrinsic tenase inhibition assay. Both assays arepredictive of activity in plasmatic systems. The extrinsic tenase assaygives insight into the influence of the peptides on (a) the interactionof FXa and TFPI and (b) the interaction of the FXa-TFPI complex with theTF-FVIIa complex. The FXa inhibition assay measures a peptide'sinfluence on the interaction of FXa and TFPI only.

The extrinsic tenase complex is responsible for FX and FIX activationupon initiation of the coagulation process. The extrinsic complex iscomposed of FVIIa, Tissue Factor (TF), and FX substrate. To determinethe influence of peptides on the TFPI-mediated inhibition of theextrinsic tenase complex, a coupled enzyme assay was established.Peptides were diluted 1/6.25 from 10 mM stocks (in DMSO) and furtherdiluted by serial ¼ dilutions in DMSO to prevent unwanted precipitation.TFPI was diluted in HNaCa-HSA (25 mM HEPES; 175 mM NaCl; 5 mM CaCl₂;0.1% HSA; pH 7.35). FVIIa, lipidated TF, phospholipid vesicles(DOPC/POPS 80/20), and chromogenic substrate specific for FXa (S-2222(available from DiaPharma, West Chester, Ohio)), all diluted inHNaCa-HSA, were added to 96-well plates. After an incubation period,TFPI and peptide dilutions were added, resulting in a finalconcentration of 2.5% DMSO. FX activation was initiated by adding FX tothe wells. FXa-mediated chromogenic substrate conversion was determinedby observing an increase in absorbance using a micro-plate reader. Theamount of FXa generated at certain time points was calculated from theOD readings. FXa generated at 20 minutes after start of the reaction wasconsidered for calculation of EC₅₀ from plots of peptide concentrationversus the inhibition of TFPI (%).

The functional inhibition of TFPI also was examined using a FXainhibition assay. A FXa-specific chromogenic substrate (S-2222) andTFPI, both diluted in HNaCa-HSA, were added to 96 well plates. Peptideswere diluted 1/6.25 from 10 mM stocks (in DMSO) and further diluted byserial ¼ dilutions in DMSO to prevent unwanted precipitation. Thepeptide dilutions (2.5 μl) were added to the 96 well plates, resultingin a final concentration of 2.5% DMSO. The conversion of chromogenicsubstrate was triggered by the addition of FXa, and the kinetics of theconversion were measured in a micro-plate reader. Because TFPI inhibitsFXa slowly, OD readings after 115 minutes were considered forcalculation of the EC₅₀ from plots of peptide concentration versus theinhibition of TFPI (%).

Results from the extrinsic tenase assay and FXa inhibition assay areprovided in Table 7 and FIGS. 22-27.

TABLE 7 FXa Inhibition Assay Extrinsic Tenase Assay % inhibition %inhibition EC₅₀ [μM] @ 2.5 μM EC₅₀ [μM] @ 2.5 μM JBT0120 0.9 45 0.9 45JBT0132 1.2 36 0.1 10 JBT0224 n.a. 26 3.5 18 JBT0303 1.2 61 n.a. 8

Referring to Table 7, JBT0120, JBT0132, and JBT0224 restored extrinsiccomplex-mediated FX activation in the presence of TFPI-1 with an EC₅₀ of<2 μM, resulting in between about 20% to about 60% inhibition of TFPIactivity. JBT0047 (EC₅₀=1.4 μM),

JBT0131 (EC₅₀=2.2 μM), and JBT0293 (EC₅₀=2.9 μM) also restored extrinsiccomplex activity in the presence of TFPI-1. In addition, JBT0120,JBT0132, JBT0224, and JBT0303 restored FXa activity in the presence ofTFPI-1 with an EC₅₀ of <5 μM, resulting in between about 5% to about 50%inhibition of TFPI activity, in the FXa inhibition assay. JBT0047(EC₅₀=0.7 μM), JBT0131 (EC₅₀=8.2 μM), JBT0293 (EC₅₀=1.3 μM), JBT0297(EC₅₀=0.6 μM), and JBT0305 (EC₅₀=2.3 μM) also restored activity of FXain the presence of TFPI-1 in the FXa inhibition assay. This exampleconfirms that peptides of the invention are TFPI antagonists.

Example 4

In this example, the TFPI inhibitory activity of peptides is establishedusing a plasma-based assay.

The influence of peptides on thrombin generation was measured induplicate via calibrated automated thrombography in a Fluoroskan Ascent®reader (Thermo Labsystems, Helsinki, Finland; filters 390 nm excitationand 460 nm emission) following the slow cleavage of thethrombin-specific fluorogenic substrate Z-Gly-Gly-Arg-AMC (Hemker,Pathophysiol. Haemost. Thromb., 33, 4-15 (2003)). Plasma from patientswith FVIII or FIX deficiency (George King Bio-Medical Inc., OverlandPark, Kans.) was obtained for testing. The residual coagulation factoractivity for each of the plasmas was lower than 1%. As a model forantibody-mediated FVIII deficiency, frozen pooled normal plasma (GeorgeKing Bio-Medical Inc., Overland Park, KN) was incubated with high titer,heat inactivated, anti-human FVIII plasma raised in goat (4490 BU/ml;Baxter BioScience, Vienna, Austria) giving rise to 50 BU/mL. The plasmaswere mixed with corn trypsin inhibitor (CTI) (Hematologic Technologies,Inc., Essex Junction, Vt.) to inhibit Factor XIIa contamination,resulting in a final concentration of 40 μg/mL.

Pre-warmed (37° C.) plasma (80 μL) was added to each well of a 96 wellmicro-plate (Immulon 2HB, clear U-bottom; Thermo Electron, Waltham,Mass.). To trigger thrombin generation by Tissue Factor, 10 μL of PPPlow reagent containing low amounts (12 μM) of recombinant human TissueFactor and phospholipid vesicles composed of phosphatidylserine,phosphatidylcholine and phosphatidylethanolamine (48 μM) (ThrombinoscopeBV, Maastricht, The Netherlands) were added. Peptides were diluted 1/7.5from 10 mM stocks with DMSO, and further diluted 1/8.33 with Aqua-Destresulting in a DMSO concentration of 12%, providing a 0.5% DMSOconcentration in the final assay mix. Just prior putting the plate intothe pre-warmed (37° C.) reader, 5 μL of HEPES buffered saline with 5mg/mL human serum albumin (Sigma-Aldrich Corporation, St. Louis, Mo.,USA) or 12% DMSO in Aqua-Dest was added, followed by addition of thepeptide dilutions or reference proteins (FVIII Immunate referencestandard (Baxter BioScience, Vienna, Austria); Factor VIII InhibitorBy-Passing Activity (FEIBA) reference standard (Baxter BioScience,Vienna, Austria); NovoSeven (Novo Nordisk, Denmark); and purified humanplasma FIX (Enzyme Research Laboratories, South Bend, Ill.)). Thrombingeneration was initiated by dispensing into each well 20 μL of FluCareagent (Thrombinoscope BV, Maastricht, The Netherlands) containing afluorogenic substrate and HEPES-buffered CaCl₂ (100 mM). Fluorescenceintensity was recorded at 37° C.

The parameters of the resulting thrombin generation curves werecalculated using Thrombinoscope™ software (Thrombinoscope BV,Maastricht, The Netherlands) and thrombin calibrator to correct forinner filter and substrate consumption effects (Hemker, Pathophysiol.Haemost. Thromb., 33, 4-15 (2003)). For calculating the thrombingenerating activity of certain peptide concentrations equivalent to thereference proteins (e.g., FVIII Immunate® reference standard, FEIBAreference standard), the thrombin amounts at the peak of each thrombingeneration curve (peak thrombin, nM) were plotted against the standardconcentrations, and fitted by a non-linear algorithm. Based on thiscalibration, FVIII Immunate, FIX, FEIBA or NovoSeven equivalentactivities were calculated. Results for various peptides are provided inFIGS. 12-18 and 28-30. Representative results are provided in Table 8.(* denotes that FVIII deficient plasma was obtained from a differentdonor.)

TABLE 8 % FVIII-equivalent activity FEIBA-equivalent activity in inFVIII deficient plasma @ FVIII inhibited plasma 10 μM peptide @ 10 μMpeptide [mU/ml] JBT0120 37.4* 298 JBT0132 5.3 41 JBT0224 16.2 191JBT0303 20.8 253

With reference to Table 8, JBT0120, JBT0132, JBT0224, and JBT0303improved TFPI-dependent thrombin generation in FVIII-depleted plasma tolevels exceeding 1% of the level of thrombin generation in plasmacontaining FVIII (% FVIII-equivalent activity). The tested peptidesexhibited approximately 5%-40% FVIII-equivalent activity inFVIII-deficient plasma. JBT0120 and JBT0132 improved peak thrombin andpeak time, dose dependently, as illustrated in FIGS. 11A and 11B.

Example 5

The following example demonstrates that the peptides of the inventioncan be modified by the addition of moieties that enhance physicochemicalor pharmacokinetic properties of the peptides. As illustrated below, theaddition of 40 kDa PEG to peptides described herein dramaticallyimproved the pharmacokinetic behavior of the peptides.

Methods of conjugating chemical or biological moieties to peptides areknown in the art. To add PEG (polyethylene glycol) to the peptidesdescribe herein, a functional group (AOA=aminooxy acetate) was added tothe N-terminus of the peptides for coupling to aldehydes and ketones.Alternatively, a cysteine was added to the C-terminal part of thepeptide for coupling with maleimid (Hermanson, Bioconjugate Techniques,Academic Press (1996)). The peptides (JBT1586)AOA-FQSKGNVFVDGYFERL-Aib-AKL-NH2 (SEQ ID NO: 166) and (JBT1587)Ac-FQSKGNVFVDGYFERL-Aib-AKLC-NH2 (SEQ ID NO: 167) were used forN-terminal and C-terminal modification with PEG, respectively.AOA-FQSKGNVFVDGYFERL-Aib-AKL-NH2 (SEQ ID NO: 166) andAc-FQSKGNVFVDGYFERL-Aib-AKLC-NH2 (SEQ ID NO: 167) were incubated withexcess 40 kDa mPEG-Propionaldehyde (SUNBRIGHT ME-400AL2, NOF, Japan) and40 kDa mPEG-maleimide (SUNBRIGHT ME-400MA, NOF, Japan), respectively.The resulting PEGylated peptides, JBT1853 and JBT1855, show similaraffinities compared to the starting structureAc-FQSKGNVFVDGYFERL-Aib-AKL-NH2 (JBT0740) (SEQ ID NO: 66).

The resulting PEGylated peptides demonstrated significantly increasedplasma stability and prolonged plasma half-life in mice. FIG. 31illustrates the results from a pharmacokinetic analysis of the freepeptide JBT0740 (Ac-FQSKGNVFVDGYFERL-Aib-AKL-NH2) (SEQ ID NO: 66)compared to the C-terminally PEGylated peptide JBT1855(Ac-FQSKGNVFVDGYFERL-Aib-AKLC(PEG(40 kD))-NH2) (SEQ ID NO: 252). Incontrast to the unPEGylated peptide, the PEGylated peptide is present athigh concentrations in mouse plasma at 100 minutes post-administration.The unPEGylated peptide is rapidly cleared from the plasma.

What is claimed is:
 1. A peptide comprising an amino acid sequence of atleast 85% identity to the sequence of formula VII: (SEQ ID NO: 1040)Ac-FYYKWH[CGMRDMKGTMSC]AWVKF-NH2, (VII)

wherein the peptide forms a cyclic structure generated by a disulfidebond between cysteines at amino acid positions 7 and 18 of the aminoacid sequence.
 2. The peptide according to claim 1, wherein the aminoacid sequence identity is at least 90%.
 3. The peptide according toclaim 1, wherein the peptide is conjugated to a polyethylene glycol(PEG) moiety.
 4. A method for treating a blood coagulation disorder in asubject, the method comprising administering to the subject a peptide ofclaim 1 in an amount sufficient to treat the blood coagulation disorderin the subject.
 5. A pharmaceutical compositing comprising a peptide asdefined claim 1 and a pharmaceutical acceptable carrier.
 6. The peptideaccording to claim 1, wherein the amino acid sequence identity is atleast 95%.
 7. A peptide comprising an amino acid sequence of at least85% identity to the sequence of Ac-SGASRYKWFCGMRDMKGTMSCVWVKFRYDTS-NH2(SEQ ID NO: 1047).
 8. The peptide according to claim 7, wherein theamino acid sequence identity is at least 90%.
 9. The peptide accordingto claim 7, wherein the amino acid sequence identity is at least 95%.10. A pharmaceutical compositing comprising a peptide as defined claim 7and a pharmaceutical acceptable carrier.